Follow
Share

My in-laws have a terrible primary care doctor. He has completely ignored their obvious mental decline and my mother in-law doesn't even like him. There is a geriatrician in the area that we'd like to take them too. Does anyone the procedure to changing a primary care doctor when you're on medicare?

This question has been closed for answers. Ask a New Question.
How do I find a doctor for a medicaid/Medicare patient who is 80 years old? Her zip code i is 75052..
Helpful Answer (0)
Report

Medicare is also available for people with disabilities who are under 65 yrs.
Helpful Answer (0)
Report

Medicare is one of the great programs that came along with Social Security. It pays approximately 80% of your doctor bills, hospital bills and add-ons. Medicare Advantage is a different program. I did have "Advantage" and switched back to Medicare. I pay the extra 20% because the supplement is too high for me, but it is very do-able for most people.
Over 65 and love'in it.
Helpful Answer (1)
Report

Just change your doctor. Medicare does not care. I have changed doctors at least 6 times before I found a great fit for me. FYI - Medicare Advantage is not regular Medicare and have different guidelines.
Helpful Answer (0)
Report

My Medicare Advantage plan changed my primary doctor without my knowledge or consent. I cannot stand this doc and want to return to the previous doc. What are my rights in this situation?
Helpful Answer (0)
Report

I do this as an occupation....First of all MEDICARE does not require you stay with any particular physician, that is straight MEDICARE. If your father has signed up with a MEDICARE HMO OR ANY HMO you MUST ONLY SEE PHYSICIANS IN YOUR PLAN OR THERE WILL BE NO REIMBURSEMENT AND YOU WILL BE RESPONSIBLE FOR ALL PAYMENTS. So you must find out if your father's benefits have been signed over to an HMO, if not, call the doctor you want to see and ask if they accept Medicare patients and if they say "yes," set up an appointment. If he is in an HMO program you can call and find out if this doctor is a member of any HMO plan, if you are very lucky it may be yours, if it isn't yours but another one, I believe you can switch plans once a year during re-enrollment only. If he does not accept Medicare you could ask to be removed from the HMO plan but that may be once a year as well. You will have to pay the 20% and non covered services that Medicare does not cover, so you would have to look into a secondary carrier or if your father is low income you may try Medicaid. We always told our patient NOT TO ENROLL IN ANY HMO PLAN as their care is restricted to one set of doctors, they become confused and say they have MEDICARE but in reality they do NOT, they assigned their benefits to the HMO who now covers them in place of Medicare. It is a bit confusing but I hope this helps.
Helpful Answer (0)
Report

Thank you, PaulaK, for sharing your very frightening experience.
I am 2-1/2 yrs away from Medicare myself. While my Internist will continue to see existing patients that age into Medicare, she will not accept new Medicare patients. I have found this policy to be rampant among my peers, and I live in a major US city.

In addition, I did not feel my parents were getting the best care from their primary care physician, so I tried to find a better dr for them, using an existing relationship with their cardiologist. The cardiologist researched, and concluded that the other PCP's that would take Medicare were not appropriate for them, due to "communication" issues, which I took to mean they were born and medically educated offshore, and would be hard for my parents to communicate with. So, we stayed with the existing dr. I suppose it has worked out ok, as my parents are at the end of their lives, and just need to be kept comfortable.

Seems to me we still have a healthcare crisis in the US, and "death panels" are automatically built into the system.
Helpful Answer (0)
Report

On paper, switching doctors should be simple and straightforward. Find a new doctor who will take Medicare (or, if your parents are on a MedAdvantage plan, who will take Medicare AND is on the MedAdvantage network), make an appointment, and fill out whatever forms you need to fill out to request that your parents’ records be sent by the old practice to the new one.

But in actual practice, the sad reality is that depending on where your parents live, they may have a great deal of trouble finding a new doctor who will take Medicare ... and if they have a MedAdvantage plan instead of traditional Medicare, having to find one who is ALSO a member of the MedAdvantage network will make it even harder.

Here’s an important cautionary tale for anyone who has not yet selected a MedAdvantage or Medi-gap plan for him/herself or his/her loved one!

My Dad lives in rural Southern Oregon. In his small town, a very limited number of doctors accept Medicare patients at all (due to the reduced reimbursement rates from the government). When Dad’s former employer switched all retirees over a certain age from their private insurance to Medicare, they sent Dad materials on all the available plans and told him to choose what he wanted. Dad was already exhibiting some lack of judgment at this point, and responded by writing back to say he was very disappointed in how they had elected to treat retirees, and that he would pass entirely on health insurance, then, thank you very much.

By the time I found out about this, there were only days left in the enrollment window to pick a plan. I knew nothing about Medicare. I got all of the plan info from his former employer and started wading through it. My eyes crossed. It looked to my untutored eyes as if a MedAdvantage plan would make the most sense, because it combined the drug benefit with the straight health care benefit. Unlike a traditional Medicare plan, a MedAdvantage plan requires you to see a doctor within the MedAdvantage network. Three MedAdvantage plans were available in Dad’s area. I reviewed the doctor directories for each and picked one that showed some 29 available primary care physicians in his town who were accepting new Medicare patients.

For the next 14 months, nothing happened. Dad didn't need to see a doctor and didn't need to fill prescriptions. We paid his premiums every month and life went on as normal. Except that his short-term memory was getting worse. Since dementia can have physical causes unrelated to the “big dementias” (i.e., Alzheimer’s, Lewy Body, FTD), I knew it was important to get him in to see a neurologist for testing. Out came the physician directory. I looked through it, found the nearest neuropsychologist, and called to make him an appointment. First problem. No neurologist/neuropsychologist would see him without a referral from a primary care physician.

My Dad refused to see his old primary care physician, who lived in a town about an hour away (traveling this distance had become difficult for Dad). So I pulled out the directory again and started calling around to set up an appointment with a new PCP. Only it turned out that those 29 available PCPs in my Dad’s town? Who were supposedly accepting new Medicare patients? Weren’t. A staggering number of them, in fact, practiced out of a clinic in town that hadn’t been accepting new Medicare patients for FOUR YEARS. When I asked why Dad’s MedAdvantage plan was allowed to list them in its directory as if they were actually available to new patients, I was told that the fact that this clinic continued to see its existing Medicare patients (even though it had cut off all new patients almost five years earlier) allowed the MedAdvantage plan to keep listing them in the directory.

It took me weeks to zero down our “real” choices to something like two doctors. Initially, I did all the work you would do if picking a doctor for yourself ... that is, reading Yelp reviews, looking at years of experience, looking at the quality of the medical school attended. But it quickly became clear to me that my “choices” were extremely limited. The doctors available to us had attended 1- and 2-star medical schools. Both were quite elderly (one had even come back out of retirement) and worked for an overcrowded family clinic in town. I picked the one that was willing to see Dad first. In FOUR AND A HALF MONTHS.

I was horrified. When I finally did get Dad in to see this new doctor, we were both singularly unimpressed. We sat in the waiting room for almost an hour after our appointment time. That man was brusque and kept asking questions we’d already answered several times. Dad hated him. He saw him one more time (this time, they made him wait TWO HOURS past his appointment time), and then categorically refused ever to go to that clinic again. I had to find him a new PCP in town, and the only other one in that network was at the same clinic. I was advised that many Medicare patients in town were choosing nurse practitioners as PCPs, so I started looking for one of those who would take new Medicare patients (and who was on Dad’s MedAdvantage network). Even that took forever, but I did finally find one ...

The whole experience was a nightmare. When the next window came to change Medicare plans, I resolved to drop the MedAdvantage plan and move Dad to a Medi-gap plan. I figured that this wouldn’t solve the fact that few doctors in his town take new Medicare patients ... but at least it would remove the additional restriction of having to find one who ALSO belonged to the MedAdvantage network.

Only ... it turns out ... and this had really not been made clear when I first waded through all of those Medicare materials to choose a plan; those materials really tout the benefits of MedAdvantage plans ... that if you choose a MedAdvantage plan instead of a Medi-gap policy when you FIRST become eligible for Medicare ... there is a chance you will NEVER be able to switch to Medi-gap!!! The reason for this is that when you first become eligible for Medicare and pick a plan, the company selling the plan HAS to sell it to you, regardless of your existing conditions. But after that ... those companies are allowed to refuse to sell you insurance based on your pre-existing conditions! And now Dad had a definitive dementia diagnosis.

It took me four long months and a lot of pain early this year to find a company that would sell Dad a Medi-gap policy with his dementia diagnosis. Thank goodness he did not have any of the other 6 to 8 conditions that would have made it impossible for him to get a Medi-gap plan. His monthly premium has more than doubled. But at least I know the next time I have to find him a doctor in his rural community, I’ll have a few more options than we did last time. Maybe not a LOT of additional options, since doctors don’t have to take Medicare, and many don’t ... but some.

The problems we experienced are not unique to southern Oregon. A quick Web search pops up stories all over the nation of patients having terrifyingly limited access to Medicare doctors in their communities. As a middle-aged person who will age into Medicare in the not-impossibly-far future, I am very afraid. Gone, apparently, will be my ability to choose a doctor based on such niceties as whether he/she has good reviews from other patients, or went to a good school. Nor do I believe Obamacare will resolve this problem, any more than Medicare has. Through my Dad’s experience, I have learned the hard way that guaranteed medical coverage does not mean guaranteed medical access ... because doctors do not have to agree to work for whatever the government or insurance companies decide they are willing to pay.

Frightening. In the meantime, keep this story in mind before you choose a MedAdvantage plan simply because it looks cheaper or includes drug coverage. And think twice about retiring to a poor or rural area, as your physician choices on Medicare are likely to be very limited.
Helpful Answer (0)
Report

The Day's Amusement (or Madness):
1. Dad breaks his hand; we get a cast and the orthopedics person at at the VA hospital says "if you can't stand it, don't take it off yourself. Call me at this very special number and come in and I will take it off.
2. Dad wears it for a few hours and whines. I tell him to stop being such a baby.
3. Did whines more and I go to work after I put his arm above his head like his ortho lady says.
4. Dad breaks down while Im gone and calls her. She doesn't answer her phone call.
5. repeat 4.
6. repeat 5.
7. I come home and dad begs me to take the cast off. I refuse.
8. Dad takes the cast off.
9. I call the ortho lady, which did hadn't been able t get through to. I cant get through.
10. I call his geriatric doc who says come in through the emergency room for a new cast. oh fine, another lost work day. not really, another lost night of sleep because I will have to get work done, sleep is optional.
11. Orthopedics call (dad doesn't answer phone) and say call us to schedule an apt to put a cast on. hey wait, he just got his 2nd one, would this be a 3rd they want to put on?
12. I call them back. refer to # 5 and #6.
13. I call his geriatrics office. they put me on hold. they come back and say "okay, ill put you through to 0ropeditics. I say no, there is nobody there. They say "well I cant make the apt". So I say, "so when you send me through and there is nobody there and no one taking messages, then what should my next step be.? and she says---wait for it----"HANG UP".
Helpful Answer (0)
Report

You may change doctors anytime you wish. This is the United States. ( I think).
Call or write Medicare and give them the name of your new PCP.
Helpful Answer (0)
Report

Check out your (potential) NEW Doc first with a 'test drive' office visit... let the NEW one know what you are doing. Sometimes, that office visit tells alot about their patience, communication skills and tolerance of you. If you like him/her + they accept you (+ Medicare)... sign a release at the NEW Doc office to release all records to the NEW doc. I HIGHLY recommend checking that NEW Doc out first...
or you will be Doc shopping again... not good!
Helpful Answer (1)
Report

I agree with all the answers given here for this question. Good luck and I hope that you can find a physician who will take Medicare. We have a problem here in CC Texas finding doctors who will take new Medicare patients. They are far a few between and sometimes you are stuck with the one you have because of this. These doctors know it and take advantage of the situation. It is a very sad result of what has happened to our Medicare program and is now happening with SS. I hope you can find a good doctor.
Helpful Answer (0)
Report

I'm on Medicare and when I dislike a doctor, I fire him/her. Just do it!
Helpful Answer (1)
Report

There is no special procedure--just do it ASAP!!! If your parents are not getting the proper care from their PCP, then shame on him. I highly recommend getting a PCP with a certification in geriatrics. Geriatricians have special training in working with the 65+ population. I think that once you make the change, you will be so very happy.
Helpful Answer (0)
Report

Just request that the old doctor transfer the records to the new doctor. We just recently did the same thing, having moved my M-I-L to our home state from Florida.
Helpful Answer (0)
Report

Agree with ejbunicorn. I just did it recently with my father. Just stopped going to the previous doctor, and began with the new one. No problems.
Helpful Answer (1)
Report

as long as the doctor accepts medicare, you can change doctors anytime you want to
Helpful Answer (1)
Report

This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter