" In July 1965, under the leadership of President Lyndon Johnson, Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history."
How much has the average US lifespan increased since 1965? It seems like the age should go up instead of down. However, is there a lot less corporate and governmental health insurance today vs. 1965?
@hoggirl the MDs that are Family Medicine/Primary Care Physicians (PCP) - their office has to ābalanceā to have a limited percentage of patients that are Medicare in order to have enough income for covering their practice costs and make a living. Specialists often do not have this issue as they rely on referrals and essentially work to keep working, and often do a lot of their stuff in the hospital ā so they make up for a lot of stuff with procedures.
There are hospitals that own practices and they have primary care physicians - so the MDs have a schedule at the clinic and have a paycheck w/o having to run a business.
I was Administrator and CFO for a specialty physician group. This is how things were handled in our area.
Now working in skilled care/rehab, I see a number of elderly patients who have specialists but no PCP - the hospital either uses a hospitalist or one of their MDs from hospital owned practice to oversee care while in hospital.
So if you have a great PCP in your area and you are an established patient, see about any changes with your care there once you are on Medicare. Typically once you are a patient, they keep you unless you become non-compliant. In our state, a MD can essentially āfireā a patient, but they have to send a certified letter and state they will continue to provide care for 60 days while the patient makes other arrangements, and will provide medical records to the new MD with patient consent.
Maybe others here can add in what they had with MDs prior and after change into Medicare.
There are Medicare Advantage (C Plan) that have networks. There are more IMHO that take Medicare B (Supplemental Plan) - nationally, so if you travel.
When H and I are older/debilitated, down the road in a limited geographic area, we may at some future date go to Medicare C/Advantage Plan.
We sign up for what we want in July for Oct 1 start of insurance strictly through Medicare/Supplement/Drug Plan on both of us. Until then we are on my health insurance with H on the free Medicare A which started June 1 (he turned 65 in June).
@bromfield2 we have some MDs in our area that are āconciergeā providers - their patients pay a specific cost/year to get health care management with that MD. IMHO the fee is reasonable if one has the money and wants a high level of physician oversight of care - the few that went into this were PCPs that were pretty expert in knowing all the best specialists and had developed a lot of relationships. This allowed them to cover their office expenses and manage their patients at a high level.
@MarylandJOE I feel for you paying 100% of your employee health insurance costs. We saved over $1K/month from COBRA cost with Hās company - when he retired earlier than I had planned ( 
) but I work enough hours to pick up insurance at my employer ā I pay $180 every 2 weeks to cover both of us on my employerās Blue Cross Blue Shield plan that was very similar the Hās employer plan. I have only a few months to go, and am getting very weary of work. I worked 4 days this last week and decided to only commit to 3 days/week because the work left for me is getting heavierā¦one evening I worked 14 hours, and two other nights I worked 10 hours. At least with 3 evenings/week I have more time to recover. I am active on the job, and my arthritic joints were really stiffening up as the night wore on. What still irritates me is that DH threw in the towel when he was making over double of what I make with less than half the effortā¦
In 2016, I got my specialist (lung md) to refer me to his internist so they could be on the same medical records system. It was a good idea as she is excellent and only accepted me because he referred me (her practice is full).
She said sheād accept my H (who is on Medicare + private BCBS) once his 70+ internist retires because itās my spouse. H hasnāt decided if he wants her (whom he hasnāt met) or will take whomever his retiring md gets to take cases from the hospital system who bought the practice.
Similarly, she said sheād only accept my 30+ year old kids if they move back to hi permanently, as they should have MDs where they live.
At the initial appt, my new internist said she has young kids snd land to keep practicing for a long time going forward, which made me very happy.
@HImom we got into our PCP group when my secretary was having care provided by him (4 MDs plus a NP) back in the early 1990ās - their practice was closed to new patients other than those a MD decided to accept through specific referral. Our PCP MD retired (he was so fabulous, he had a super wide knowledge base and also knew all the best specialists) and his replacement washed out and they took time to get the 4th MD; so another in his practice also retired and a MD hired in that had done research for a while and had his own solo practice before coming into the group - so we asked if he could be our PCP and he accepted us. He is very thorough in our care. I coordinate what I know with questions for him and advice on our care.
My cardiologist (I donāt have cardiac issues but had two very big cardiac work ups due to the chemo/drugs that were needed for me during cancer treatments) - his daughters and our daughters attended the same Montessori and were in class together - and I knew his wife. So in mid-sized city sometimes a small world. DH will get a big cardiac work up once on Medicare ā I suspect he has Paroxysmal A Fib which may have been from having Covid (Dec 2020). He also experiences some symptoms after his 2nd Pfizer Covid vaccination. Right now I am having DH notate every time he is experiencing his āheart flutteringā and any other symptoms.
Our PCP is doing a research study with Covid, and due to my elevated lab values (I had Covid also Dec 2020 and I had Pfizer Covid vaccinations a bit earlier than DH through work in health care), I am signing on with the study. I am going to put a note in that he may want to include DH on the study as well.
My former internist and his partner had a HUGE practice and saw generations of patientsāmy folks, us and my adult kids, as well as many other families. As the internists got older and their patients got older, times needed for visits increased and their own personal health issues increased, making their practice run more and more behind schedule in seeing patients (could be hours waiting to be seen for apptāliterally).
My former internist had hip replacements in his late 60s and was never the same afterwardsāI was fortunate to get referral for new internist shortly thereafter.
We switched my folks to excellent geriatrician. My other sibs have found new internists except my single brother. Iām reluctant to refer him because he is NOT a good or even a polite patient.
He has multiple health issues he refuses to treat and gets mad when test results show he has condition and md recommends treatment he doesnāt want, so he swears at the md and or provider!
When I spoke with him during our often interrupted lunch, he said maybe heād go to his friendās wife, since sheās an md. I said sheās a concierge md who charges $1500/yr to be in her practice. (Bro can easily afford it, but he was shocked and found that unappealing.) I donāt want to refer him to anyone because he swore at my former lung doc for telling him the bro has severe sleep apnea and bro refuses to use cpap. He also swore at and denigrated at my staff when they were performing lung tests at his request at my free health event. The lung tests showed his lung function is poor but instead of following up with his doc, he preferred abusing my staff. 
@HImom the concierge MD rate for your brother is small potatoes esp for a guy like your ill mannered brother to health care providers ā and if your brother became that MDs patient I wonder how long he would be kept due to his abusive nature and non-compliance.
I agree - keep your care providers away from your brother! Your brother is his own worst enemy with his anger, denial and blaming others for his medical situation and conditions.
The fee has risen to $1800/yr. Iād think most mds would fire him due to his noncompliance and abuse. I have to limit my time with this family member as I find him tiring and tiresome.
Bro came to one of the appts between my dad and dadās excellent geriatrician. Bro kept repeating polypharmacy (like wow, just learned a new word). I asked bro several times which meds heād like to have adjusted or what he was proposing and he had nothing to say.
He may have to settle for urgent care or switch to HMO like Kaiser where you get assigned someone or see md of the day.
My neighbors who are Medicare-age switched from BCBS to Kaiser because their MDs kept retiring and they found it tiring to keep searching for new MDs who would accept new patients.
Based on what you wrote, it seems surprising that he would get any medical care at all other than if he arrived by ambulance.
Heās an adult. He can find his own way, one way or another.
You would be surprised as some of the abusive behavior people have. One son who saw both his mom and step dad act out was on the phone with a relative āwell you know how easy going dad is - and he just is not himselfā. Well the two of them were awful to every care provider including asking some African American CNAs if they were going to treat ādadā well! āDadā came from a VA Hospital where he was only one of the 3 patients assigned to RN/LPN and the wife stayed in recliner/at bedside 24/7 - and the step son told me he has not been alone overnight for 10 years. They found fault with every single thing and criticized every single thing. They acted out with our very nice social service personnel as well. She did find other placement for him. Crazy that the wifeās mom had been a resident of ours after the larger city where they live were unsatisfactory.
Sometimes āhired helpā - meaning staff at hospitals or other facilities get lashed out to and are treated very badly.
They donāt get it that you attract bees with honey and not vinegar; but people get angry about things including their shrinking world when they are in rehab or in skilled care.
@himom the concierge MD here was charging over $10K a year and getting it - and our cost of living is low compared to Hawaii.
I was not the person objecting to the charge. Sheās not my md tho she does see some of my friends. It was something that took bro aback as he was unaware there were at much things as concierge MDs with extra costs.
Iām happy with my MDs and specialists.
Is there are shortage of non-Kaiser primary care physicians accepting new patients in Hawaii?
@HImom I know it isnāt you objecting to the concierge MD charge, and with some of your friends seeing this MD I would also keep MD away from your brotherā¦
Sounds like your brother is generally not a go along kind of guy and generally not very happy eitherā¦
Our entire state is short of healthcare workers, especially MDs. Our cost of living is very high and wages & medical reimbursements are very low. This isnāt improving. Our med school is graduating under 75 MDs/yr, which is far under the # of MDs retiring (plus many of our MDs are 60+ years old).
I feel very fortunate I was able to get a new primary care doc from my lung specialist and she and I get along very well. I suspect I could also have chosen to go to one of my board members, who is an internist as well, but feel this is cleaner, with fewer overlapping roles.
I have tried broaching the subject about broās medical care but will let him navigate his own path. Heās burned a few bridges. Heās one of those folks who just get mad if they hear info/news they dislike (shoot the messenger school). 
This article says 47% of HI MDs are refusing new Medicare patients. Yup, that would make finding a primary care md (or any md) tougher if youāre on Medicare.
Interestingā¦ here is the Kaiser Hawaii availability directly from its web site:
57 out of 78 PCPs in Kaiser on Oahu are accepting new patients, and 97 out of 137 PCPs in Kaiser statewide are accepting new patients.
Of course, people who already have a number of physicians (PCP and specialists) whom they regularly use and want to keep may find that crossing the Kaiser / non-Kaiser barrier to be difficult and not worth it if they need to change just one of their physicians (due to retirement or whatever).
Yes, most Kaiser MDs are required to accept new Kaiser patients. Still only 20% or so of our state is covered by Kaiser. Most of the rest are BCBS. Those MDs have no similar requirement to accept new patients.