Which Medicare Plans Do Doctors Prefer?

Medicare plans, Medicare Part C or more appropriately called Medicare replacement plans, are insurance plans offered by private insurers that take the place of the traditional Medicare plan offered by the federal government. With traditional Medicare, a portion of the Social Security benefits withheld from the monthly allotment pays for the Medicare premium. With Medicare replacement plans, the participant pays a premium to the private insurance plan for her coverage.

Companies that Offer Medicare Replacement Plans

• The most popular Medicare plans offered by private insurers are through Humana and Anthem Blue Cross and Blue Shield. Other, smaller insurance companies also offer Medicare replacement plans, including Pyramid and Sterling Options. Several smaller private insurance companies were quick to offer Medicare replacement plans, only to decide later on that these plans were not profitable and decided to end their coverage. Some of these plans merged with larger insurance companies, while others simply left their participants looking for another plan.

Coverage

• When it comes to coverage by private Medicare replacement plans, doctors prefer the larger companies, as these companies have a quicker payment turnaround than the smaller companies. Most larger companies also accept claims by electronic submission, eliminating the lengthy task of printing paper claims and mailing them to the companies. Unfortunately, many smaller companies offering Medicare replacement plans still require the physician's office or billing company to submit their claims on paper.

Acceptance

• Another reason physicians prefer larger insurance companies is that they are usually already in network with these companies, doing business with them as commercial insurance providers. Often the paperwork and time involved to get in network with smaller insurance companies simply is not worth the effort if only a handful of patients are affected. If you are interested in a Medicare replacement plan, make sure your physician and local hospital or clinic will accept this insurance as coverage.

Reimbursements and Patient Payments

• Overall, Medicare supplement plans usually reimburse the physician at or slightly above regular Medicare rates. This, in conjunction with the quick turnaround of private insurance companies, makes many of these Medicare replacement plans quite desirable to physicians. These plans usually require a co-pay amount for the patient to pay at each office visit. If you are contemplating one of these plans, take into account the amount you will have to pay in co-payments versus the traditional 20 percent coinsurance amount you will have to pay with a traditional Medicare plan. You need to also weigh the amount of the monthly premium for Medicare supplement plans versus the amount of Social Security withheld to pay for a traditional Medicare premium.

Prior Approval for Testing

• In this aspect, most physicians prefer traditional Medicare over Medicare supplement plans. Traditional Medicare does not require precertification for most outpatient procedures, so the staff saves time by not having to pre-certify tests the physicians order. Private Medicare replacement plans, however, frequently require physicians to pre-certify all outpatient testing, sometimes making it difficult to get necessary testing scheduled for their patients.