Your Medicare Advantage Doctor Might Break Up With You

I was fired or broken up with (dumped some would say) from a doctor’s practice. I still have the letter telling me not to come back…

We had a difference of opinion about when to schedule my surgery. Instead of him allowing me to transfer to another doctor in his practice that was available to do my surgery in a convenient time for me, he terminated me from the practice. My situation really doesn’t apply to this article, but I want you to know, people get broken up with all the time, for many reasons.

In This Article I’ll Discuss Your Financial Value to Your Doctor

I’m not referring to doctors who dump a patient that is disruptive or behaved inappropriately to the staff. Not I’m a referring to patients who violate controlled substance policies. Clearly you see where the doctor needs to cut ties with those patients as well as those who refuse to pay their bills. Afterall, your doctor is a business person.

I’m talking about the ability of your doctor to maximize profits off of your behavior. Namely, you coming in for follow-up visits and getting your annual preventative health care. You are taking up a valuable spot on your doctor’s roster. Due to time constraints, she can only have a limited number of patients. Within that number, she will most likely have a limited number of spots for Medicare patients. This is a financial decision based on the lower amount of Medicare payments vs. higher payments for those on employer group health plans.
You Could Be At Risk of “Being Broken Up With”

If you are a patient that isn’t following doctor advice, and you have a managed care plan, you could be fired. Not because your doctor hates you per se, but because your doctor can easily replace you with another new Medicare patient who will follow advice. In many areas, it’s hard to find a doctor this is accepting new Medicare patients, so if you have a good doctor, don’t take it for granted you can keep her.

Behind The Scenes

Isn’t one Medicare patient as good as the next? Doctors get paid extra when you behave a certain way. If you get an annual flu shot, your doctor gets paid. If you get an annual mammogram, your doctor gets paid. These payments are in addition to the office visit, they are similar to bonuses. Doctors earn a lot from managed care companies in the form of these bonuses. Doctors can lose money if you don’t come in at all. Managed care plans want you to see your doctor at least once a year, even if you are perfectly health and think it unnecessary. You have ideal weight, you check your blood pressure at Walmart, you’ve never smoked or drank and you run marathons. Those health people still get cancer and the insurance company can save a lot of money if your cancer is detected at stage 1. Patients who refuse to come in at all are at risk of being fired.

“The government is trying to stretch the Medicare trust fund by keeping you healthy.”

Thinking of your doctor as a business is hard for most people. All doctors want to stay in business and that means they can’t neglect the bottom line. As much as your doctor loves his job and “isn’t in it for the money” if he accepts managed care contracts, he is contractually obligated to rid the practice of non-compliant members because the bonuses the insurance companies earn from Medicare are also on the line. Ah ha. If you are enraged about this overreach, you now know where it originated: the government. The government is trying to stretch the Medicare trust fund by keeping you healthy. Again, to catch disease in its earliest stages or to prevent it entirely. While it feels intrusive, Medicare is a social program. Statistically, you’ll get much more out of Medicare than you ever paid into the program in your payroll taxes and Part B premiums.


Sylvia Gordon and her sister, Rebecca, run Gordon Marketing, one of the nation’s largest Medicare FMO/NMA offices. They have a team of over 100 that train and support independent insurance agents in all 50 states. You can find Sylvia’s weekly posts on LinkedIn and the sisters' Youtube channel posts 2 training videos each week. Contact Sylvia at or 800-388-8342.