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Starting Jan 1, 2019, doctors who don't accept Medicare won't be able to write a prescription that you can fill with your Part D drug plan.

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certifi...

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intercst
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Starting Jan 1, 2019, doctors who don't accept Medicare won't be able to write a prescription that you can fill with your Part D drug plan.

I wonder how extensive that problem is. If a doctor doesn't accept Medicare, won't most Medicare (and therefore, Part D) people going to someone else?
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I wonder how extensive that problem is. If a doctor doesn't accept Medicare, won't most Medicare (and therefore, Part D) people going to someone else?

Concierge doctors are becoming quite the thing around here. They charge you a monthly fee for unlimited access to office hours. Our neighbor was telling us their doctor daughter started this last year and is already not taking new clients. She was tired of dealing with insurance and being limited to a 15 minute office visit that in her opinion did not allow her to take the time to understand her client. Her fees are intentionally reasonable as she purposefully serves a less affluent community, though one still needs insurance for hospitalization and no doubt testing/meds would be great. She does not accept insurance of any kind, so that would cause a problem with the new Medicare Part D rule.

IP
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I wonder how extensive that problem is. If a doctor doesn't accept Medicare, won't most Medicare (and therefore, Part D) people going to someone else?

Concierge doctors are becoming quite the thing around here. They charge you a monthly fee for unlimited access to office hours. Our neighbor was telling us their doctor daughter started this last year and is already not taking new clients. She was tired of dealing with insurance and being limited to a 15 minute office visit that in her opinion did not allow her to take the time to understand her client. Her fees are intentionally reasonable as she purposefully serves a less affluent community, though one still needs insurance for hospitalization and no doubt testing/meds would be great. She does not accept insurance of any kind, so that would cause a problem with the new Medicare Part D rule.


Are many of her patients people on Medicare? That is, people who have Medicare but are paying their own fees to her without Medicare kicking in anything?
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Are many of her patients people on Medicare? That is, people who have Medicare but are paying their own fees to her without Medicare kicking in anything?

I don't know if any of her clients are on Medicare, but all of her clients pay their own fees to her without insurance kicking in. She does not take insurance any more. More doctors are rejecting the restrictions taking health insurance imposes on them. According to her parents, her monthly fee is quite reasonable and it is often cheaper to pay her monthly fee and avoid the co-pays that are required by insurance. I would potentially chalk this up to marketing, but then again in less than a year she is filled to capacity and no longer taking new patients, so it must work well for both sides.

I for one am looking for a doctor who doesn't do my appointment while looking at a stop watch. I want a partner in health, not just someone to slap band aids on, treating the symptoms of a problem with meds rather than going after the root cause of the problem.

IP
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Direct pay primary, monthly subscription model.

First no harm to patients -- includes do no financial harm.

This Dr's practice:
$50/month adult
$10/month child
in office procedures all covered under subscription
all consumables and prescriptions at cost
Outside services and meds negotiated prices by the office

https://www.youtube.com/watch?v=KrGKfollEd0


longer form, more detail about costs/services as seen by the customer and how the revenue works out (favorably) for the Docs:

https://www.youtube.com/watch?v=bGZaRnC1wNg
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inparadise analyzes,

According to her parents, her monthly fee is quite reasonable and it is often cheaper to pay her monthly fee and avoid the co-pays that are required by insurance. I would potentially chalk this up to marketing, but then again in less than a year she is filled to capacity and no longer taking new patients, so it must work well for both sides.

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I bet this is a case of people being "bad at arithmetic". If you have one of these concierge docs, you still need to carry health insurance which is going to cover doctors, lab tests and hospitalization -- two out of three which you're now "double paying" to the concierge doc.

This might work out OK if you're healthy and your medical expenses are always below the deductible of your health plan. But if you get sick and have expenses above the deductible, the concierge doc is definitely going to cost you more than a provider you can bill "in-network" to your health plan.

intercst
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I bet this is a case of people being "bad at arithmetic". If you have one of these concierge docs, you still need to carry health insurance which is going to cover doctors, lab tests and hospitalization -- two out of three which you're now "double paying" to the concierge doc.

Yes, as I said in my first post a high deductible insurance at a minimum is required. Again, the doctor has already reached max participation in less than one year, so there are definitely enough people out there with the details who feel it works for them.

IP
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Are many of her patients people on Medicare? That is, people who have Medicare but are paying their own fees to her without Medicare kicking in anything?

I don't know if any of her clients are on Medicare, but all of her clients pay their own fees to her without insurance kicking in. She does not take insurance any more.


The point of the article was the law saying that doctors who don't accept Medicare won't be able to write a prescription that you can fill with your Part D drug plan. So if none of her patients are on Medicare insurance, then none of them have Medicare Part D for prescriptions, right? So this law doesn't restrict her for writing scripts for her patients.
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The point of the article was the law saying that doctors who don't accept Medicare won't be able to write a prescription that you can fill with your Part D drug plan. So if none of her patients are on Medicare insurance, then none of them have Medicare Part D for prescriptions, right? So this law doesn't restrict her for writing scripts for her patients.

No kidding. And if you go back to my original post about the doctor, the point was that the use of concierge doctors is on the rise, at least in this area, so it's very possible that these concierge doctors may be writing scripts for Medicare patients that won't be able to be filled by Medicare Part D. But no, I don't have a list of these concierge doctors clients so I can't say for sure, just as you can't say for sure that there are not doctors out there who don't take Medicare and are writing scripts for Part D.

What I can say for sure is I don't understand why the gov't feels the need to restrict the 65+ community to certain doctors if they choose to go elsewhere. Making meds more expensive because you want to go to your own doctor rather than that of the gov'ts choice seems like a contraindication to good health and unnecessary.

IP
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pts for Medicare patients that won't be able to be filled by Medicare Part D. But no, I don't have a list of these concierge doctors clients

Realistically, I wonder how many people WITH Medicare are going to concierge doctors who don’t accept Medicare? I’m guessing the number is very, very small, and for those doing this, I’m also guessing that they’re not that concerned with Rx costs.
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Realistically, I wonder how many people WITH Medicare are going to concierge doctors who don’t accept Medicare?

I would guess anyone who doesn't want their doctor running the appointment on a 15 minute timer, want a doctor to help you obtain good health, not just treat the symptoms. As I said in my first post, concierge doctors are not always expensive and the doctor I referenced actually serves a low budget populace. According to her parents her monthly fees are often less than what a family would pay in co-pays if they had insurance. We live in an area with many very affluent people who would not balk at the $70/month fee, (parents not sure if that is individual fee or family,) but would think twice if their very expensive meds also had to be from cash. The doctor fee for us would be easy, the cost of meds crippling.

It's an industry I personally don't know much about other than it seems to be on the rise, with the referenced doctor having taking no more new patients after less than a year, so she at least is obviously a very good value based on people voting with their checkbooks.

IP
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What I can say for sure is I don't understand why the gov't feels the need to restrict the 65+ community to certain doctors if they choose to go elsewhere. Making meds more expensive because you want to go to your own doctor rather than that of the gov'ts choice seems like a contraindication to good health and unnecessary.

You need to be more paranoid.

It's because the government views it as more a power thing than a "health" thing. Note that in other countries and the Hillary-care that they tried to push through back in the Clinton presidency, they basically attempt to forbid doctor care and health care that is outside the government system.
IIRC, Canada did this until they had a court decision that said "access to a waiting list is not access to health care".

Making meds more expensive is a cudgel to force people into not using a doctor who doesn't do Medicare.
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