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What are Medicare Physicians?

By Erin J. Hill
Updated May 17, 2024
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Medicare physicians are doctors who are able and willing to accept patients who receive Medicare benefits. In many cases, a physician within a private practice may choose whether or not to participate in the Medicare program. Some physicians may choose not to accept Medicare patients because they are often reimbursed an amount that is less than they would traditionally charge a patient, or than they would receive from a private insurer. Most hospitals and government-owned medical centers are required to accept Medicare.

The Medicare system works similarly to a private insurer, although it is funded by the government. Patients pay a premium every month that is generally much lower than one could expect to pay to a traditional insurance company. All remaining costs of coverage are paid with government taxes, which are usually taken out of payroll checks. There are four parts to Medicare, but each covers certain aspects of health care for the patient. Medicare physicians accept patients and receive the required co-pay up front, and are then reimbursed by the Medicare program for their services.

Patients who are covered by Medicare Part C, or the Advantage plan, are offered more customized services which enlist private insurers to help cover some of the costs. These plans may be more pricey, but more Medicare physicians may be available to choose from, along with specialists for those who have certain conditions. Not all patients are eligible for this plan. This is a convenient plan, however, for those who want to keep their usual doctors even if they are not Medicare physicians.

To find Medicare physicians, patients should contact a Medicare office. There are generally lists of available doctors within a specific area to help patients make a choice about where to receive their care. In some cases, doctors who are not Medicare physicians may be willing to take the necessary steps to accept Medicare patients if petitioned by Medicare or an existing patient who wishes to remain within the practice. This is not always an option, however, since some doctors may not be willing or able to accept Medicare.

In many cases, Medicare physicians have to meet certain guidelines in order to be eligible to accept Medicare patients. These may vary based on locations and specialty. Physicians who wish to accept Medicare should contact the appropriate government officials. Certain adjustments may need to be made in the practice before Medicare can be accepted.

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