Drop in acceptance occurs as payment rates decline for Medicaid primary care physicians in many states
SUNNYVALE, Calif., Feb. 26, 2015 /PRNewswire-USNewswire/ -- Given the size of the Medicaid program and its importance to America's low-income population, HealthPocket examined government records on Medicaid acceptance for a broad cross-section of healthcare providers. HealthPocket's review of over one million records found that in 2015 only 34% of the healthcare providers examined were listed as accepting Medicaid insurance. The 2015 results represent a 21% decrease from the listings of Medicaid acceptance as compared to 2013 data for the same categories of healthcare providers.
Since both the 2013 and 2015 analyses relied upon the same government data source and provider categories, the marked decline in Medicaid acceptance is significant. In particular, the data calls into question whether the temporary two-year increase in Medicaid payments to primary care physicians effected any lasting improvements to Medicaid acceptance.
Healthcare provider reluctance to accept Medicaid has numerous reasons, most notably the level of reimbursement from Medicaid for healthcare services. Medicaid typically pays 61% of what Medicare pays for the same outpatient physician services. Medicare itself typically pays 80% of what commercial health insurers pay. Consequently, in comparison to commercial health insurance from private insurance companies, Medicaid payments represent a reduction on a reduction.
"HealthPocket has stressed many times that health insurance is only as good as the doctors and hospitals that accept it," said Kev Coleman, Head of Research & Data at HealthPocket, "In the case of Medicaid, there is an overwhelming number of healthcare providers who do not accept the insurance which, in turn, undermines the value of the insurance provided."
The results of HealthPocket's study can be reviewed in the article "Medicaid Acceptance By Healthcare Providers Falls in 2015."
HealthPocket.com is a free website that compares and ranks all health insurance plans, helping individuals, families, and small businesses to make their best health plan decisions. HealthPocket publishes health insurance market analyses and other consumer advocacy research. HealthPocket's research is nonpartisan and uses only objective data from government, non-profit, and private sources that carry no conditions that might restrict the site from serving as an unbiased resource. HealthPocket, Inc. is independently managed and based in Sunnyvale, California. Learn more at www.HealthPocket.com.
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