Can I keep my doctor on Medicare? This is one of the biggest questions seniors ask before they turn 65. The answer depends on which plan you pick. With one type of plan, you can see almost any doctor. With another, you are limited to a network. Here is what you need to know before you sign up.
The short answer
You can keep your doctor on Medicare. But how easy that is depends on the plan you choose.
Original Medicare lets you see almost any doctor in the country. Medicare Advantage is different. It uses networks, and not every doctor is in every plan.
How Original Medicare works with doctors
Original Medicare is run by the government. Most doctors in the country accept it. As long as your doctor accepts Medicare, you can see them. There is no list to check. There is no referral needed for specialists.
If you have a Medigap plan with Original Medicare, the same rules apply. Any doctor who takes Medicare will take your Medigap.
How Medicare Advantage works with doctors
Medicare Advantage is different. These are private plans. They build networks of doctors. If your doctor is in the network, you pay a small copay. If your doctor is not in the network, you pay much more, or in some plans, nothing at all is covered.
The network for a plan in Cleveland is different from the network for a plan in Cincinnati. Even within the same insurance company, the networks can differ by zip code.
How to check if your doctor is in a plan
Before you pick a Medicare Advantage plan, do this.
Step 1: Make a list of every doctor you want to keep. Include your main doctor, every specialist, and the hospital you would want to go to.
Step 2: Call each doctor's office. Ask which specific Medicare Advantage plans they take. Get exact plan names.
Step 3: Match those plan names to the options in your area. Only consider plans that include all of your doctors.
This is not optional. This is the most important step in picking a Medicare Advantage plan.
What if my doctor leaves the network?
This happens. Insurance companies and doctors negotiate every year. Sometimes they cannot agree, and doctors leave a network.
If your doctor leaves your plan's network, you have options:
- Pay the higher out of network rate, if the plan allows it
- Wait until fall and switch to a plan your doctor takes
- Find a new doctor in network
Plans have to give you notice when this happens. They will mail you a letter.
Do all doctors take Medicare?
Not all of them. About 98 percent of doctors who treat seniors accept Medicare. A small number, especially in concierge or boutique practices, do not.
If your doctor does not accept Medicare, you have three choices:
- Pay them out of pocket
- Find a new doctor who takes Medicare
- See if they offer a private contract option
Most people end up finding a new doctor, because the out of pocket cost is too high.
Hospitals and Medicare
Hospitals work the same way as doctors. Most accept Medicare. Some Medicare Advantage plans have a smaller list of hospitals. If you have a hospital you would want to go to in an emergency, make sure it is in the plan before you enroll.
A simple rule
If keeping every one of your doctors is the most important thing to you, pick Original Medicare with a Medigap plan. You will have the widest access.
If you are open to changing doctors, or you have already checked that your doctors are in the Medicare Advantage plan, Medicare Advantage can save you money each month.