How to Determine Whether Your Practice Should Accept Medicare: An Interview with an Active “Old Geezer”

This is blog documents Erin’s interview with Royal J., a retired college professor, world traveler, father, and… Medicare recipient.  Many of our clients are young practitioners looking to open their practices, and are thus trying to decide whether or not they should accept Medicare.  We encourage each client to make the best decision for their goals and practice, but we also hear lots of misconceptions about who “Medicare patients” are.  As with all stereotypes and misconceptions, this one is begging to be broken.

Q: Royal, you’ve been on Medicare for more than a decade now, after years of private insurance. Do you feel like you’re treated differently by healthcare providers or their offices? If so, in what way? When you switched from private insurance to Medicare, did you lose access to any of your providers?

Yes and no (Medicare patients being treated differently.)  Some medical providers will not accept Medicare patients, but in my community of Santa Fe, New Mexico, this isn’t common.  The general care and treatment provided does not differ from what I can determine.  Some surgical procedures such as cataract removal has providers who will not serve Medicare patients because of the lower rate of compensation offered by Medicare.

Also, be aware that once eligible for Medicare, you have to sign up and I think there is even a penalty if you don’t.  Private insurers won’t accept you if you are eligible for Medicare.  It’s the “secondary” insurance where the Medicare recipient has choices.  I was astonished to learn, on signing up years ago, that the secondary automatically disallows any claim that Medicare won’t pay.  I had thought that it was a fall-back, but not so.

Q: If you wanted to see a physical therapist, for example, who doesn’t take Medicare, what would you do?  Assume that you can afford to pay them cash for their services.  What’s your understanding of whether or not you’re “allowed” to see that provider?  Do you think you can see them and just pay cash, since they don’t take Medicare?

First, try to get a recommendation from a friend or acquaintance.  Then, instead of reading the comprehensive booklet provided by Medicare — which I should do — on what is covered, I’d simply call the therapist’s office and ask if the treatment is covered.  Medicare doesn’t require prior approval like many insurance policies.

Can I simply see them and pay cash?  You bet, they love cash.

Q: Would you be surprised to learn that’s not true? If a PT doesn’t participate in Medicare, they can’t see you at all.

Yes! Does that apply to all medical specialties?  Interesting.

Q: Some providers think of Medicare recipients as the stereotypical “old geezer.”  That’s not you.  There are many young providers who want to focus on “active” or “athletic” populations, and I think they forget that this includes a huge chunk of Medicare recipients.  What’s one thing you’d want to tell them to change this misconception?

The gyms and related training facilities are crowded with “old geezers,” often outnumbering the “youngsters” by large numbers.  As we age, we become much more aware of the benefits of good health and the absence of disabilities.  We also have more discretionary time than the working population.

A significant incentive in recent times has been the introduction of programs such as Silver and Fit (my program) and Silver Sneakers, which are entirely paid by secondary insurers to encourage healthy exercise programs for Medicare recipients.

Q: Let’s consider the Medicare population: everybody in America who’s 65 and older. You’ve shared with me some thoughts about how our older population is treated in general.  Can you elaborate?

One of my aging friends says that, “We’re invisible,” i.e., he believes that younger people see little relevance of oldsters (anybody over 35-40 years of age), thus we’re not really seen…we’re invisible.  This might seem a bit harsh, but as an individual who has extensively lived in Latin America and Spain, one has to conclude that the elderly are definitely viewed by those cultures in a more favorable light.  The offset for this opinion in America is that we’re economically important as many of us have significant financial resources after a life of work.  Money talks.

Q: You work out at the gym frequently, eat right, travel the world, and go for long walks.  These are habits and routines that many young providers seek to teach their clients, but it often feels like an uphill battle.  What motivates you, and how have you maintained these habits?

Once arriving to a relatively healthy state (a relative condition) it becomes obvious that it’s more fun and productive to be well, healthy and physically active, than to be a sickly couch potato with continuing ailments that limit access to the good life.  There are so many healthful avenues in America — food, exercise, physical/mental stimulation, compared to other countries in which I’ve lived — that it’s easy to pursue such desirable outcomes once they are understood.

Q: When you do need medical care, how long do you usually need to wait to see a provider?

This depends on the nature of the malady, illness, injury.  A standard once-a-year physical (Medicare pays for one such general physical a year) must be set months in advance with my doctor.  A severe fall and resulting injury to a hip got me in to see my GP within a day.  Great response time!

Q: As a college professor, you counseled many students about to launch their careers. Do you have any words of advice for a young physical therapist, just graduating from their doctoral program, who’s looking to open their own practice?

Don’t view your initial formative professional education as an end point, but rather as a continuing opportunity to improve skills, knowledge and insights into your chosen profession.   Sometimes my students, on graduating with their B.S. degrees in Forestry, would view their educational achievements as a completed stage of life with no further need of growth.  A profession, whether it be physical therapy or other fields, is not just a job but a life commitment to growth and development.  

Q: Any parting words of wisdom for providers, students, or everybody reading this?

My success in reaching 79 years of age might be attributed to moderation in the usual “abuses”–alcohol, drugs, tobacco, stress, excessive food and lots of exercise every day.  Had I subscribed to this regimen when I was in my 30’s and 40’s, it would have been even more prudent — maybe leading me to tip over the century mark.  But who really wants to do that?

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

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