Martha Buisman of Gorham considers herself lucky to have had quality health insurance during her adult life. She had a “gold standard” health insurance plan when she worked for the United States Postal Service for 29 years.
Now retired, the 71-year-old has traditional Medicare with a supplemental federal plan from Blue Cross Blue Shield — coverage she considers top notch.
So she was shocked when she learned surgeons at InterMed, which has practices in Portland, South Portland and Yarmouth, would not take her traditional Medicare plan when her doctor referred her to the medical group for a gynecological surgery in April.
InterMed, which employs more than 200 physicians and other providers in primary care and specialties, told her it accepts Medicare Advantage plans as well as traditional Medicare plans from existing patients, but it does not accept traditional Medicare from new patients or those being referred for care.
After paying into Medicare for decades, Buisman said she was flabbergasted as to why any medical provider wouldn’t accept the federal insurance for Americans 65 and older — or be allowed to not accept it.
“It’s inexplicable to me because everybody in the country is forced to pay into Medicare their whole lives,” Buisman said. “You’ve got thousands and thousands and thousands of dollars in this nationwide system. Now any old provider can just say, ‘Screw you, we’re not taking Medicare.’ I mean, if everybody did that, then we’d have no health care system at all.”
Medicare covers about 20% of the United States population but 27% of Maine’s population — and more people are signing on each year as they age. Many choose traditional Medicare. But a growing number in Maine are picking a Medicare Advantage plan, which must be approved by Medicare but is offered by private insurance companies. Medicare Advantage plans often bundle all the coverage into one plan rather than break it up into Medicare Part A for hospital coverage, Part B for medical coverage and Part D for prescription coverage.
The vast majority of medical providers across the country — an estimated 99% of non-pediatric physicians — still accept Medicare, according to KFF, a health policy research institute. But some doctors and policymakers have raised concerns in recent years that providers will opt out of Medicare due to reductions in Medicare payments for many Part B services, potentially creating a shortage of doctors willing to treat people with Medicare, according to KFF.
It’s not clear which providers in Maine have opted out of Medicare, but, as of 2024, 1.5% of Maine physicians had done so, according to KFF.
InterMed confirmed that it currently accepts new patients enrolled in certain Medicare Advantage plans but does not accept new patients with traditional Medicare, including outside referrals. Patients who are already established with InterMed can continue receiving care when they transition to traditional Medicare, however, allowing them to continue receiving care from doctors they already know. Its policy has been in place for at least five years.
“We recognize how important it is for patients to have access to the care they need. Like many medical practices, InterMed must balance growing demand for services with the resources available to provide high-quality, reliable care to our patients. We regularly evaluate our policies as patient needs and healthcare conditions evolve,” Roger Poitras, CEO of InterMed, said in a statement.
It is rare for general physicians and surgeons, such as those with InterMed, to opt out of Medicare. Nationwide, psychiatrists opt out at the highest rate, 8.1%, according to KFF. Next highest are plastic and reconstructive surgeons, with 4.5% opting out, and neurologists, with 3.2% opting out.
Casey Schwarz, senior counsel for education and federal policy at the Medicare Rights Center, said there’s no mechanism in the United States to compel providers to accept all Medicare patients that come to them. In this case, InterMed is still accepting some Medicare patients.
“If we had a situation where a provider was required to accept any Medicare patient who wanted to be seen by them, they couldn’t manage their patient population,” Schwarz said.
For Buisman, the idea that providers won’t accept certain Medicare patients reflects a two-tiered system. She and her husband each pay $203 a month out of their Social Security checks for Medicare, plus an additional $304 a month for their supplemental plan. That’s $6,084 a year each.
“If it gets to a point where so many providers are allowed, apparently, to just withdraw from the Medicare system, and then all the rich people can just pay for their concierge doctors, and then screw the rest of us. The whole trend is very disturbing,” she said.
In the end, Buisman went back to her doctor and got a referral for a different surgeon. She had hoped to have a female surgeon because it was a gynecological surgery, which is how she ended up at InterMed. But now she is working with a male surgeon who takes her insurance, and she is happy with him, she said.
“It all worked out, but it just sticks in my craw that the whole thing happened at all,” she said.
Open enrollment for Medicare plans began Oct. 15 and runs through Dec. 7.
Have you encountered a Maine doctor who doesn’t take Medicare? Please write to reporter Rose Lundy at rose@themainemonitor.org. We will not use your information without your permission.
This story was originally published by The Maine Monitor, a nonprofit and nonpartisan news organization. To get regular coverage from The Monitor, sign up for a free Monitor newsletter here.