AGE SPOTS: What is an opt-out doctor?

We have been hearing from a few seniors who are concerned that their doctors may soon no longer accept Medicare because of the changes happening in the law. I thought the following article might offer some information in which you might be interested.

This information is republished with permission from the Medicare Rights Center. For more information visit www.medicarerights.org.

An opt-out doctor is a doctor who does not accept Medicare at all. Doctors who have opted out of Medicare can charge their Medicare patients whatever they want. These doctors don't submit any health care claims to Medicare. In addition, opt-out doctors are not subject to the Medicare laws that limit the amount that doctors can charge their patients. When you see a doctor who has opted out of Medicare, you pay the entire cost of your care, unless it's an emergency or you need urgent care. Generally, Medicare does not pay for health care services you receive from an opt-out doctor.

If your doctor has officially opted out of Medicare, your doctor must have you sign a private contract that states that you agree to receive care from a doctor who has opted out of Medicare. If you sign this contract, you are responsible for the full cost of health care services you receive from the opt-out doctor. Keep in mind that doctors who have opted out of Medicare can charge you as much as they want. In addition, you cannot get Medicare reimbursement for health care services received from an opt-out doctor.

If your doctor has opted out of Medicare and does not ask you to sign a private contract before providing you with Medicare-covered health care services, you will not have to pay anything for health care services you received. Your doctor must refund you any money you've already paid for those services.

If you have Original Medicare, the traditional Medicare program offered directly through the federal government, you will pay the least for doctor's services if you see a doctor who accepts Medicare and takes assignment. A doctor who takes assignment accepts Medicare's approved amount as full payment for health care services. Contact your doctor's office to make sure that your doctor accepts Medicare and takes assignment. You can also call 800-MEDICARE or visit www.medicare.gov to find doctors who accept Medicare and take assignment.

If you have a Medicare Advantage plan, also known as a Medicare private health plan, you should see doctors within your plan's network. You typically pay the least if you go to a doctor who is in the plan's network. Check with your plan to see what rules apply.

For more free, useful information about Medicare, go to www.medicareinteractive.org.

On a completely different matter: The annual Law Enforcement Memorial to honor local law enforcement officers fallen in the line of duty will be held at 10 a.m. Friday, May 10 at Cape Bible Chapel, 2911 Kage Road in Cape Girardeau. All are welcome. Please come and show your support for our officers who place their lives on the line every day to keep us safe.

About Ruth

Ruth Dockins is public information director for the Southeast Missouri Area Agency on Aging.