Transitioning to Medicare can feel overwhelming, especially when it comes to ensuring continuity of care with your current doctor. For many people, maintaining a relationship with their trusted physician is a top priority. The good news? Whether you can keep your doctor largely depends on the type of Medicare plan you choose and your doctor’s participation in Medicare.
Original Medicare: Flexibility with Providers
If you enroll in Original Medicare (Part A and Part B), you have the freedom to see any doctor or healthcare provider who accepts Medicare. The key is to confirm that your doctor participates in Medicare, as not all providers do. Fortunately, most doctors and hospitals across the United States accept Medicare, giving you a wide range of options.
However, keep in mind that Original Medicare doesn’t include prescription drug coverage, which requires enrolling in a separate Part D plan. Additionally, Original Medicare doesn’t cap out-of-pocket expenses, so some people opt for a Medicare Supplement (Medigap) plan to help with these costs. These plans don’t restrict your choice of doctors as long as they accept Medicare.
Medicare Advantage: Provider Networks
If you choose to enroll in a Medicare Advantage (Part C) plan, the situation is a bit different. These plans are offered by private insurance companies and typically operate within a network of providers. Whether you can keep your doctor depends on:
The Plan’s Network: Medicare Advantage plans often have networks that include specific doctors and hospitals. If your doctor is in the plan’s network, you can continue seeing them. However, if they’re out of network, you may need to switch doctors or pay higher out-of-pocket costs.
Plan Type: Different Medicare Advantage plans, like HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations), have varying rules about seeing out-of-network providers. HMOs typically require you to stay within the network, while PPOs offer more flexibility at a higher cost.
Steps to Ensure You Can Keep Your Doctor
Ask Your Doctor: Confirm with your doctor’s office whether they accept Medicare or are included in specific Medicare Advantage plan networks.
Review Plan Options Carefully: Before choosing a plan, check its provider directory to ensure your doctor is included. Provider networks can change yearly, so it’s important to review this during Medicare’s Annual Enrollment Period (AEP).
Consider Your Priorities: If keeping your doctor is essential, Original Medicare with a Medigap plan might be the best fit. If you prefer the additional benefits Medicare Advantage offers, verify that your doctor is in the plan’s network.
When Changes Are Necessary
If your current doctor doesn’t accept Medicare or isn’t in the network of your chosen Medicare Advantage plan, you may need to find a new provider. This can be a difficult adjustment, but it’s an opportunity to find a doctor who meets your needs and works well with your Medicare coverage.
Final Thoughts
Maintaining a strong relationship with your doctor is an important part of managing your health. By understanding your Medicare options and doing some research upfront, you can make an informed choice that allows you to continue receiving care from a doctor you trust.
If you have questions about your options or need help navigating the transition to Medicare, don’t hesitate to reach out to a Medicare expert for guidance.
Ready to start a plan? Call us (971) 233-3637. Our assistance is at no cost to you.