TONI SAYS: Help…doctor is not accepting medicare?

By Toni King

Hi Toni: This week, I went to see my primary care doctor and his office manager informed me that they are no longer accepting Medicare. I recently enrolled in Medicare and will have to pay upfront the complete bill and be reimbursed by Medicare. His office is a small office, and the paperwork is killing him. Also, he will be retiring soon, so I need to find a new doctor. Can you please tell me what I need to do to submit this doctor visit and get reimbursed? Thank you so much

— Susan


Hello Susan: In these trying healthcare time, smaller medical providers whether a primary care or a specialist may be opting out of the Medicare system.

They are not accepting Medicare as your doctor is doing and will not bill Medicare for you either. They want you to submit the claim to Medicare and wait to be reimbursed.

Did the doctor charge Medicare rates or charge you their rates and want you to be reimbursed from Medicare what Medicare will pay? That is what it sounds like to me.

I am hearing through the Medicare grapevine from clients that come in the Toni Says® office for a Medicare consultation that a few older primary care and medical providers are retiring. The office paperwork whether it is for Medicare age patients or under 65 medical claims is very overwhelming.

My advice to clients who are new to Medicare to begin searching for medical providers that are accepting Medicare, especially when a serious health issue is involved.

I have not heard of this type of problem with larger medical offices, especially those who are part of a hospital system.

Below are tips that the Toni Says® Medicare team tell clients which can help you:

1. Before you set the appointment for your medical visit, ask the doctor’s office, if they are still accepting Medicare. Most important, that they are accepting new Medicare patients and will that office bill Medicare directly.

2. If they say NO, then you need to decide…Do I want to pay out of pocket and get reimbursed what Medicare pays. Doctors know they are not paid their asking rates. Medicare is not the only one who discounts the doctor’s bills. Group and individual health insurance plans with network providers, also discounts the doctor’s bills…. OR…

3. Look for a doctor or specialist that does take Medicare assignment and will bill Medicare. There are doctors and healthcare professionals that still accept and bill Medicare and are accepting new Medicare patients. Even top medical professionals in their specific field still accept Medicare. Ask your primary care doctor for more than one doctor or provider that he/she recommends for your specific medical situation.

Here is how to file a claim if your doctor does not accept Medicare assignment. You may have to pay the complete bill and submit the claim to Medicare. Look in the Medicare and You Handbook, which explains how to submit a claim. You need to call 1/800-MEDICARE (633-4227) and ask for Form CMS-1490 or go to When you contact Medicare ask them for help filing the claim and they will be happy to assist.

There are specific Medicare rules regarding changing Medicare plans. Call the Toni Says® Medicare Hotline at 832-519-8664 or visit the Toni Says® website at Stay tuned for the Confused about Medicare Workshops coming during Medicare’s Annual Enrollment in the fall.

Confused about Medicare Zoom webinar is Thursday April 28 at 4:00 p.m. Visit to sign up for the Toni Says online webinar event.