There are a number of concerns about how these changes will impact patients and the entire Medicare program. One of the main issues is that the changes to the private contracting rules will result in higher costs for Medicare beneficiaries, many of whom are already living on incomes of $24,000 a year or less and have little to no savings. The more physicians who opt to privately contract with Medicare patients, the more patients may be expected to pay the higher costs for the services they receive.