Provider Acceptance High for Privately Insured, Medicare Patients

Most office-based physicians accept both new Medicare patients and new privately insured patients, indicating that Medicare beneficiaries have similar access to physicians as individuals with private insurance, an issue brief from the Kaiser Family Foundation (KFF) found.

Private payers offer higher reimbursement for physician services than Medicare, which pays physicians based on a fee schedule. This has led to concerns that physicians limit their acceptance of new Medicare patients due to the low reimbursement.

Researchers analyzed data from the National Electronic Health Records Survey (NEHRS) from 2011 to 2019 to determine the share of physicians accepting new patients across Medicare and private insurance.

In 2019, 95 percent of office-based physicians accepted new patients, with 89 percent accepting Medicare patients and 91 percent accepting privately insured patients.

The share of physicians accepting new Medicare patients remained stable between 2011 and 2019, increasing by only one percent from 88 percent to 89 percent, with minimal fluctuations during the years in between.

The percentage of physicians accepting new privately insured patients saw a steeper increase, going from 81 percent in 2011 to 91 percent in 2019.

While most office-based physicians accepted new patients under Medicare and private insurance, acceptance varied slightly among primary care physicians and medical and surgical specialty groups.

For example, medical specialists (95 percent) and surgical specialists (99 percent) were more likely to accept any new patients compared to primary care physicians (89 percent).

This trend was similar for Medicare and privately insured patients, with 83 percent of primary care physicians accepting new Medicare patients and 86 percent accepting privately insured patients. Meanwhile, 96 percent of surgical specialists and around 87 percent of medical specialists accepted new patients under Medicare and private insurance.

Nearly one in five general or family practice and internal medicine physicians were not accepting new Medicare patients or new privately insured patients, the brief noted.

When examining 12 common specialties, researchers found that most specialties had similar acceptance rates for new Medicare and privately insured patients except for obstetrics and gynecology. Obstetricians and gynecologists were more likely to accept new patients with private insurance (99 percent) than Medicare patients (93 percent).

New patient acceptance rates for Medicare and private insurance were significantly lower for psychiatrists than other specialties, with 60 percent accepting new Medicare patients and 59 percent accepting privately insured patients.

There was minimal geographic variation in the share of physicians accepting new Medicare patients. In 23 states, 90 percent or more of physicians accepted new Medicare patients. In 24 states, between 80 and 90 percent of physicians accepted Medicare patients, while less than 80 percent accepted Medicare patients in just three states and the District of Columbia.

New patient acceptance rates were also relatively high in primary care and mental health professional shortage areas (HPSAs). In counties designated as primary care and mental health HPSAs, 89 percent of physicians accepted new Medicare patients and around 90 percent accepted privately insured patients.

Medicare beneficiaries and privately insured individuals also had equal access to physicians in both rural and urban areas, the brief noted.

Physicians younger than age 65 (89 percent) were more likely to accept new Medicare patients compared to older physicians (82 percent). Meanwhile, physicians in solo practices were less likely to accept new Medicare patients than in practices with more than one physician.

Physicians may choose to opt out of the Medicare program and enter into private contracts with Medicare patients, but the KFF brief found that only one percent of physicians opted out in 2022.

Opt-out rates were highest among psychiatrists (7.5 percent), with psychiatrists accounting for 42 percent of all physicians that opted out. This finding, coupled with the low new patient acceptance rates among psychiatrists, raises concerns about access to mental healthcare providers for Medicare beneficiaries, the researchers noted.

However, most physicians generally had high acceptance rates for new Medicare patients.

“Despite concerns that lower physician fees paid by Medicare relative to fees paid by private insurance may disincentivize physicians from taking Medicare patients, our analysis suggests that Medicare beneficiaries continue to have good access to physicians, similar to people with private insurance,” the brief concluded.