Doctors and Medicare: Everything You Need to Know

Often times, whenever beneficiaries acquire a new insurance policy, they worry about losing access to their current physician. They may also worry about being limited to just a few doctors in their plan’s network. The same holds true for Medicare. New Medicare enrollees want to know how Medicare affects access to doctors. Fortunately, the relationship between doctors and Medicare is not overly complicated.

Does Medicare Restrict Which Doctors I Can See?

In short, yes, Medicare does restrict which doctors you can see to a certain degree. When you enroll with a Medicare plan, you have a large network of doctors to choose from. While you will have a lot of options, it doesn’t guarantee that the doctor you want will be covered by your plan. Additionally, you may encounter issues when you visit the doctor of your choice. Some medical facilities only take patients with Original Medicare, while others only accept Medicare Advantage plans. This can further limit your access to doctors. Nonetheless, both Original Medicare and Medicare Advantage generally offer enough choices to satisfy most patients’ needs.

Can I Change Doctors With Medicare?

With Original Medicare or a Medicare Advantage plan, you can request a new Primary Care Physician (PCP) at any time. You can also go to any doctor that is covered within your network. Moreover, if you add a Medicare Supplement plan to your Original Medicare, you can go to any doctor that accepts Medicare patients, even if they are outside of your network.

How Do I Keep My Favorite Doctors?

In most cases, it’s pretty easy to keep the doctors that you like. Once you’re enrolled in Medicare and have a network of doctors to choose from, you can see if your favorite doctors are covered. Since Medicare tries to offer a vast array of options, you’ll likely find a few doctors in your area that are covered. However, things get a little more complicated if you change addresses. You may have a new network with different doctors. You’ll need to confirm the details of your new network when you move.

What Happens If My Doctor No Longer Accepts Medicare Payment?

If your doctor “opts-out” of Medicare, any procedures you get with that doctor will not be covered under Medicare. Doctors can also opt-out of individual procedures. This means that they do not accept the Medicare-approved cost of the treatment. Often times, you can still get the treatment you need, but your doctor will likely charge a 15% “limiting charge.”

Bottom Line

If you’re planning to enroll in Medicare soon, you might be worried that you’ll lose access to your favorite doctors. Thankfully, most Medicare beneficiaries can keep their Primary Care Physicians and change doctors as needed. Medicare provides older adults with a wide range of options when it comes to in-network doctors. Additionally, you can get a Medicare Supplement plan to have even more ways to customize your healthcare.

If you’d like to learn more about doctors and Medicare coverage, feel free to fill out the form or give us a call anytime. Our licensed agents are focused on giving you the information you need, with zero pressure to enroll in a plan.