Looking For A New Family Physician? Your Choice Could Hinge On Insurance

THURSDAY, Oct. 29, 2026 (HealthDay News) — Kristin Kuhns thought she’d planned out her upcoming year’s medical coverage as well as could be done.Kuhns had chosen her Medicare options and had decided which new doctor she wanted based on recommendations from family and friends.“I’d heard that they were very attentive, and that they were doing more than the minimum for their patients,” said Kuhns, 69, an artist instructor living in Salem, Oregon.Just one problem – the doctor she wanted wasn’t taking new Medicare patients..The doctor’s clinic “had a number that new patients called, and it was like there was a guy who was a gatekeeper,” Kuhns said. “It seemed like if you had the special code word, you might get a different response, but if you didn’t it was the same answer every time – no, they’re not taking anyone.”Kuhns wound up waiting until her insurance went into effect Jan. 1, then participating in a mad dash to find a new doc.This is a problem more Americans are facing, regardless of the type of insurance they have, experts say.The United States has a growing shortfall of physicians, with 40,400 to 70,600 additional family doctors, internal medicine physicians and pediatricians needed within the next decade or so to ensure care for every American.But insurance issues are already making it a challenge for people like Kuhns to get the doctor they want, or any doctor at all. That's because some physicians are refusing to take on new Medicaid and Medicare patients due to low reimbursement rates.Folks aren’t necessarily better off if they have private insurance through their employer or an Affordable Care Act Marketplace. Many of those plans feature provider networks that do not cover the doctor they want – or even mislead about which doctors are actually available.“It’s got people saying 'there’s got to be a better way,' ” including universal coverage through a Medicare-For-All plan, said Dr. Joe Betancourt, CEO of the Commonwealth Fund, a healthcare think tank.“Opponents bring up that old boogeyman, government insurance, saying it’s going to lead to long wait times and not being able to get the care you need,” Betancourt said. “But people are experiencing that right now with the current insurance structure, right? You can’t leverage that boogeyman as much as you could in the past, given what we’re seeing with medical debt, affordability and complexity.”Access Under MedicareThe shortage of family medicine doctors and primary care physicians has led to people scrambling to find a doctor, but Medicare and Medicaid patients appear to have been disproportionately affected, said Dr. Jane Zhu, a primary care physician at Oregon Health and Science University in Portland.“I’ve been hearing from patients for quite a while now that they were having trouble getting access to primary care and getting into clinics,” she said.A “secret shopper” study for which Zhu was a senior researcher found that only about three-quarters (77.5%) of nearly 800 clinics in four major U.S. cities were taking new Medicare patients.Clinic access varied widely among the four cities, which were Chicago, Los Angeles, New York City and Portland, Ore.Only 1 in 3 (35%) of primary care clinics in Portland were accepting new patients, compared to about 97% of clinics in Los Angeles, 93% in Chicago and 82% in New York, according to results published in the journal Health Affairs Scholar in March.And even when Medicare patients did find a clinic that would take them, they faced a median wait time of two weeks before they could get in to see a doctor, researchers found. (Median means half waited longer, half for a shorter time.)Again, Portland was the worst, with wait times of about two months for Medicare patients compared to eight days in New York, 11 days in Chicago and 14 days in Los Angeles.“Where you lived really mattered,” Zhu said.Some doctors aren’t interested in taking Medicare patients because the program’s payments lag behind what doctors are paid through private insurance, she noted.“It’s well-documented that physicians and clinicians get paid less for seeing a Medicare and particularly a Medicaid patient than they do for a patient that has commercial insurance,” Zhu said.Family medicine and primary care rank among the top 10 specialties in which doctors opt out of Medicare, according to a 2025 KFF analysis.About 1.7% of family medicine/primary care doctors opt out of Medicare, but there are a lot more doctors in that specialty — about 154,750, not to mention another 217,609 in internal medicine, KFF found.That means family medicine/general practice doctors represent nearly 22% of all doctors that opt out of Medicare, and internal medicine physicians represent another 13%.The Problem With Medicare PaymentsUnless there’s a major shake-up of the system, it’s unlikely that Medicare will ever pay as well as private insurance, warned Sophia Tripoli, managing director of health policy with Families USA.That’s because Medicare sets the payment benchmark for the entire health care system, she said.“That payment reimbursement rate set by Medicare is the closest we have to an accurate approximation of the true cost of providing care for a particular service,” Tripoli said. “It’s the best we’ve got.”It’s from that benchmark that private insurers set their own payment rates for doctors.“They take the Medicare rate and they increase the reimbursement as a percentage of Medicare,” Tripoli said. “They’re battling not over who’s providing the best care at the right price, but how much money can I extract out of the system. It creates this inflated payment on the commercial side.”And if that puts Medicare at a disadvantage, it leaves its sister public coverage plan for low-income people, Medicaid, even worse off.Medicaid only paid about 71% of what doctors could expect to receive from Medicare in 2024, including 69% for office visits, according to a May 2025 analysis in the journal Health Affairs.“The other thing about Medicare is even though it’s the best approximation we have for the true cost of care, it still has flaws, right?” Tripoli added. “It under-reimburses for primary care, it under-reimburses for behavioral health services – for key functions of the health care system that we know make the difference in coordinating patients’ care, making sure they’re getting the care they need at the time they need it.”Ghost NetworksCommercial insurance shares another access problem that plagues Medicare and Medicaid – the existence of "ghost networks," where many listed physicians may, in fact, be unavailable.Ghost networks involve out-of-date provider directories that supposedly list all of the doctors who are available through an insurance plan’s network.Insurers create these networks to help contain costs, Zhu said.“From a plan’s perspective, you want to have doctors who you know are not wasteful, who provide good, cost-effective care,” she said. “Having a network is one lever by which plans are able to negotiate that.”But researchers are finding that some insurance plans aren’t regularly updating their in-network provider directories.“The list of providers that plans give to their patients that say who is in network is often very inaccurate,” Zhu said. “They’re often wrong in terms of who’s active in those networks, who is accepting new patients, what the specialties are."A review of the physician directories offered by five major U.S. insurers in 2022 found errors and inconsistencies in 4 out of 5 (81%) entries, according to a March 2023 research letter in the Journal of the American Medical Association.Another analysis found that nearly 18% of the primary care providers listed in Medicare Advantage plan directories were ghosts, according to results published in February in the journal Health Services Research.The directories are “supposed to identify who’s in network and who’s out of network, so you can learn about the cost and the coverage associated with that provider,” Tripoli said. “But there’s nothing in there. The data’s not meaningful.”The Centers for Medicare and Medicaid Services have introduced a new Plan Finder that can help patients like Kristin Kuhns figure out which doctors are really “in network” for any given Medicare Advantage plan.However, only 15% of seniors have heard of the new search function, according to a report this month from the University of Michigan National Poll on Healthy Aging.Deductibles MatterExperts say other cost-control measures common to private insurance also limit average folks’ access to a family doctor.For example, people might not be able to afford the deductibles or co-pays associated with visits to their family doctor, Tripoli said.“You see high-deductible plans where patients on the private side are exposed to $1,000, $2,000, $5,000, even $10,000 deductibles,” Tripoli said. “Most people just don’t have that cash on hand in this economy to be able to foot a $5,000, even $1,000 deductible before their coverage kicks in.”These cost-sharing measures have added to the amount of medical debt Americans face, Betancourt said.About one-third (32%) of working-age adults with private insurance are paying off medical bills or debt over time, a recent Commonwealth Fund report found.Rates were highest for people with low or moderate incomes (38%); women (37%); Black Americans (41%); Hispanic Americans (38%); and people living in the South (39%).Further, 30% of those with medical debt said they’d delayed or avoided visiting the doctor or seeking other needed medical care, the report added.In other words, even people who are signed up with a doctor might not be able to afford a visit, based on their insurance.“We may want to beat up on the public payers (Medicare and Medicaid) about how they may not reimburse enough, but we have individuals who have insurance through their employer and it’s still not affordable to people,” Betancourt said.Be PreparedGetting past all these obstacles to find a family doctor and actually see them is worth it, Kristin Kuhns, the Oregon patient, said.“The first appointment I had with her, I told her I’m really kind of falling apart because I had a delayed grief thing from my mom’s death,” Kuhns said. “She was like, 'Oh, would you like to meet a behavioral health person? I can bring her in and meet you.' It was seamless.”Kuhns said she’s a smarter healthcare shopper than some, because she and her husband are both contractors and have been getting their insurance through ACA Marketplaces for years now.“I just feel better prepared,” she said. “I have navigated the healthcare marketplace to see how much do we want to pay, do I think I’m going to have surgery this year? I’m accustomed to having to see if doctors are in a network or not.”Nonetheless, “there are so many obstacles that it often seems like the aim isn’t to be helpful. The aim is to make it more difficult,” Kuhns said.SOURCES: Kristin Kuhns, Salem, Oregon; Dr. Joe Betancourt, CEO of the Commonwealth Fund; Dr. Jane Zhu, primary care physician, Oregon Health and Science University in Portland; Sophia Tripoli, managing director of health policy, Families USA; Health Affairs Scholar, March 2026; "How Many Physicians Have Opted Out of the Medicare Program?", KFF, January 2025; Health Affairs, May 2025; Journal of the American Medical Association, March 2023; Health Services Research, February 2026; "Choosing Medicare Coverage: Older Adults’ Views and Experiences," University of Michigan, October 2026; "How Medical Bills and Debt Impact Americans with Private Insurance," Commonwealth Fund, September 2026 .Sign up for our weekly HealthDay newsletter

Looking For A New Family Physician? Your Choice Could Hinge On Insurance

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