When choosing a Medicare plan, one important factor to consider is finding doctors who accepts Medicare near you. No matter if you are looking for a clinic, hospital, new doctor, or if you just want to keep the doctor you’ve been seeing, finding out who takes Medicare is important. It all comes down to doing a little research before you schedule your next appointment and asking the right questions at your next visit.
Keep reading to learn more about finding a doctor who accepts Medicare near you and why it matters.
Of course, you can see a doctor who does not accept Medicare, but you may be charged a higher rate for your visit and any services you receive. This means your healthcare may be considerably more expensive.
By choosing a doctor who accepts Medicare, you’ll ensure you are charged the negotiated and acceptable rate. Your doctor’s office will also bill Medicare for your visit. In most cases, a doctor who accepts Medicare will also wait to hear back from Medicare before asking you to pay any cost difference if appropriate.
Whether or not you’ll need to stay within a provider network depends on the type of plan you have.
If you have original Medicare, there are no networks, you’ll just need to ask if the doctor accepts Medicare. If you have Medicare Part C (Medicare Advantage), it’s more likely you’ll have to stay within your plan’s network of doctors.
If you buy a type of Medicare Advantage plan called a Health Maintenance Organization (HMO), you’ll be given a list of in-network providers to choose from. If you decide to select a provider who is out of network, you may owe a higher cost or the full out-of-pocket amount for those services.
If your Medicare Advantage plan is a Preferred Provider Organization (PPO), you’ll typically have a bit more freedom to choose your preferred physicians. There is still a network, but you’ll pay less if you use in-network doctors and more if you use out-of-network doctors.
As long as your current doctor accepts Medicare, you should be able to see them and receive coverage for the visit. However, if they decide not to accept Medicare or stop participating in the program, you will need to find another doctor.
If you’re joining a Medicare Advantage plan, you can contact the insurance company directly to find out if your preferred doctor is covered in the network. If not, you can either choose a new doctor or a new insurance provider.
There are a few simple ways to find a doctor who accepts your Medicare plan:
- Visit physician compare. The Centers for Medicare & Medicaid Services (CMS) has a tool that allows you to look up doctors near you and compare them side-by-side.
- Check the Medicare website. The official Medicare website has many resources for finding providers and facilities that accept Medicare near you. For example, you can find and compare hospitals or other providers and search what services are covered by your Medicare plan.
- Check your insurance company provider listings. Medigap and Medicare Advantage are Medicare plans provided through private insurance companies. To find doctors that accept these forms of coverage, you’ll need to check with your selected provider for a listing.
- Check your network. If your Medicare coverage is provided through an insurance provider with a network of doctors and hospitals, check with the company to be sure your doctor is in their network This can be done by calling your insurance provider or checking their website.
- Ask trusted friends and family members. If you have any friends or family members who also use Medicare, ask them about their healthcare providers. How attentive is the doctor? Does the office handle their requests promptly and with ease? Do they have convenient hours?
For most people, having a doctor they trust who is located conveniently is an important part of their healthcare. While it is an extra step, it’s important to verify that your doctor accepts Medicare coverage or is in your Part C network to ensure you get the most from your Medicare benefits.