If you’ve been lucky enough to find a physician you’ve developed a rapport with, it can be upsetting to think about changing providers. Depending on the Medicare plan you choose, you may be able to keep seeing your doctors.
If you choose Original Medicare, you usually won’t have to pick a primary care doctor. However, if you do, it’s essential that you choose from doctors who accept assignment if you do decide to pick a primary care physician out. There are three options for primary care doctors for people who have Medicare. If the doctor wants to care for Medicare patients, they must:
- Become a fully participating provider who accepts Medicare reimbursement rates as the full payment.
- Become a non-participating provider who will accept Medicare patients but won’t accept Medicare reimbursement payments as the full payment.
- Opt out of Medicare entirely.
If your primary care doctor participates in Medicare, you’ll have to pay 20% of Medicare’s allowable charges. The Part B deductible also applies. If you pick a non-participating primary care provider, they can charge up to 15% more for their services than the Medicare set rate.
If you have Original Medicare, you can go to any doctor who accepts Medicare patients. However, you do want to call the doctor’s office and double-check that they will take new Medicare patients before you make your appointment.
Medicare Advantage Plans with Provider Networks
Depending on the type of plan you choose, you might have to pick a primary care doctor. If you enroll in a Medicare Advantage HMO plan, you may have to choose a primary care physician. This is the doctor who will oversee your medical care, and they will give you the referrals you need for specialist care or diagnostic tests. With some Medicare Advantage plans, if you decide to see a specialist without getting a referral first, your insurance may not pay for it. This is why it’s so important to know rules surrounding primary care doctors and your plan to keep your costs low.
If you belong to one of these types of plans, the plan may require that you pick out a primary care doctor from a specific list of doctors within the plan’s network. If you go this route, you’ll know that this doctor is a participating Medicare provider inside the plan’s service area.
If you didn’t have to pick out a primary care provider when you enrolled in the Medicare Advantage plan, you could double-check with the plan provider to see if the doctor you want is inside your plan’s network. If you find out that the doctor isn’t inside the plan’s network, you may need to switch to one that is in the network or switch out Medicare Advantage plans. There are specific times that you can sign up for or switch out your plan each year. Some Medicare Advantage plans, like a PPO, may allow you to see doctors and specialists outside of your plan’s network for a higher cost.
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