Private Contracts Between Doctors and Their Medicare Patients: Current Law, Proposed Changes and Implications for Beneficiaries
Under current law, physicians may choose to privately contract with their Medicare patients, though very few do. Under such arrangements, doctors can charge their Medicare patients any amount they determine is appropriate for their services rather than be bound to Medicare’s set fees and balance billing limits, so long as the patients agree, and the contract complies with requirements in current law designed to protect consumers.
Some Republicans in Congress have proposed to ease restrictions on private contracting in Medicare, which could broaden its practice. A new issue brief from the Kaiser Family Foundation explains how private contracting works under current law as well as existing protections for Medicare patients. It describes how legislative proposals would expand opportunities for physicians to privately contract with their Medicare patients, and explores the potential implications of these proposals for people on Medicare.
Supporters say that making it easier for doctors to enter into private contracts could boost the number of doctors willing to accept Medicare patients because it would allow doctors to charge more for Medicare services, increase physicians’ revenues from their patients on Medicare, and provide more autonomy for physicians than allowed under current law. However, critics of easing restrictions say that if private contracting becomes more common, a growing number of seniors could face higher fees for physician services, and have greater difficulty finding affordable care.