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Medicare pays doctors less than private insurance

Industry News | Sep 21, 2015



Medicare is an ideal option for seniors. And, according to a recent CNNMoney article using data from the Centers for Medicare and Medicaid Services and Truven Health Analytics, it pays doctors 80 percent of what private insurers do.

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Those shopping for Medicare supplemental insurance are likely encouraged by the recent data, showing that a number of medical procedures were significantly less with Medicare. Here's some examples:

  • An office visit cost $76 with private insurance and $70 with Medicare
  • A colonoscopy costs $639 with insurance and only $426 with Medicare
  • A gal bladder removal cost $945 compared to $651 with, you guessed it, Medicare

"Medicare doesn't negotiate rates," Stuart Guterman, vice president at The Commonwealth Fund, told CNNMoney. 'It sets them."

And while it would appear that doctors are getting the short end of the stick, Medicare patients typically need more coverage, giving them more business. The article points out that 4,000 doctors were paid $1 million from Medicare, so things aren't all bad for the lower bills.

So, where Medicare can allow its users to secure doctors for lower rates, the same luxury couldn't be awarded to private insurance companies, or else a doctor could simply skip out o n that provider.

"When you want to market your health plan, you want to say all the great doctors are in your network," Anne Fischer, director of Truven's Center for Healthcare Analytics, told the news source.

Securing a low Medicare rate
Seniors shopping around for Medicare supplemental insurance in the light of the recent data should do a few things:

  • Decide what parts they want, for example, if they want medication covered then they would need Medicare part D
  • Use comparison tools to compare multiple providers
  • Analyze this information to make a more informed buying decision