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Medicare Patients’ Access to Physicians: A Synthesis of the Evidence

Congressional debates about the Medicare Sustainable Growth Rate (SGR) raise questions about whether doctors are willing to see Medicare patients. This issue brief examines multiple data sources to assess beneficiaries’ access to physicians, particularly vulnerable beneficiaries with greater health needs and other disadvantages. It examines the share of doctors who are participating physicians as well as those who have opted-out of the Medicare program to privately contract with Medicare patients. It includes State analyses of rates of physicians who are accepting new Medicare patients as well as patients with private health insurance and Medicaid.

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The Henry J. Kaiser Family Foundation

Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services

As the Congress continues to work on reforming Medicare payments for physician services, a new Kaiser Family Foundation brief examines key provisions in current law that help provide safeguards and financial protections for beneficiaries when they visit their doctor, and explains how potential changes could affect beneficiaries, providers, and the…

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Visualizing Health Policy: Physicians and Medicare

This infographic illustrates information about Medicare’s payment formula for physicians and about access to health care for people covered by Medicare.

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The Henry J. Kaiser Family Foundation

Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services

This issue brief explains provisions in current law that shield beneficiaries from unexpected and confusing charges when they see physicians and practitioners—namely, the participating provider program, limitation on balance billing, and conditions on private contracting for doctors who opt out of Medicare or join “concierge” practices. It also analyzes the implications of modifying these provisions for beneficiaries, providers, and the Medicare program.

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