Finding a doctor you feel comfortable with is essential to maintaining your health. However, with Medicare, you might wonder which practitioners you can see. Here are a few frequently asked questions to help you understand the rules regarding Medicare, provider networks, and other issues. 

A Guide to Seeing a Doctor When You Have Medicare

Can I see any doctor when I have Medicare?

While the network for Medicare providers spans the entire United States, you might still be limited in which physicians you can visit. Those who accept Medicare may limit their practice to existing patients, so they won’t accept any new patients. Eligible doctors may also only accept existing patients who have transitioned from another type of insurance. 

How much will I be charged when working with a physician who accepts Medicare assignments?

In this case, Medicare stipulates the amount paid for the treatment, and the doctor providing care agrees to that amount. 80% of the costs for covered treatments will be billed to Medicare, while the remaining 20% will be your responsibility to pay.

What happens if I want to see a doctor who doesn’t accept Medicare assignments?

There are two options. The physician can reject the assignment, or the amount stipulated by Medicare, which means you’ll be required to pay 35% instead of 20%. You may also be obligated to pay a 15% excess charge.

Other physicians opt out of Medicare entirely, which means you would be charged the full cost for the treatment. 

What is a Medigap card?

Your Medigap card supplements care provided through original Medicare. This includes costs for Medicare Part B, which covers services like outpatient and preventative care. The Medigap card can also help pay for Medicare Part A, which covers hospitalizations. 

In Kailua-Kona, HI, Drs. Donald Nikaitani and Richard Pekala of Kona-Kohala Health Care Services accept Medicare coverage and provide exemplary service to patients. Along with preventative care, the board-certified doctors perform a wide range of diagnostic testing to get to the bottom of your symptoms and find the right treatment. Learn more about this clinic’s personal care philosophy online, or call (808) 329-1346 to schedule an appointment today.