There are three categories of physicians when it comes to original Medicare. By far the largest category are those that accept Medicare assignment. The second group consists of doctors that are contracted with Medicare but do not accept Medicare’s payment schedule as payment in full. This group of physicians are allowed to charge up to 15% more than what Medicare allows. The Blue Cross and Blue Shield of Arizona Senior Security Plan G Medicare supplement policy covers the 15%. The third category of physicians are those that do not have a contract with Medicare. These doctors don’t file claims with Medicare and bill the patient directly. The patient cannot file a claim with Medicare, they are responsible for the entire bill. About 1% of all physicians in the country (954,000) do not contract with Medicare. The majority of doctors that do not participate in Medicare are psychiatrists and pediatricians.
The majority of the 1% practice medicine in affluent areas of the country. Patients of the 1% are paying 100% of the cost of care, and this care is quite expensive as there are no contracted negotiated rates involved.
A decade ago, about 3% of doctors did not participate in Medicare. Today, many doctors are part of large practices owned by hospitals, and the vast majority of hospitals are contracted with Medicare. In fact, the only large hospital in Arizona that is not contracted with Medicare is Mayo in Scottsdale.