Find Out If Your Doctor Accepts Medicare Advantage

One of the most important parts of your healthcare is choosing your doctor. Everyone wants to see a doctor that understands their needs and doesn’t cost an arm and a leg. But not all doctors accept Medicare. So, how do you navigate finding a primary care physician that accepts Medicare near you?

Medicare Benefits Solutions

Aug 31, 2021

 4 minutes read

There are tools and resources available to help you find a doctor that accepts Original Medicare and Medicare Advantage plans. For example, if you have Original Medicare, you can visit any doctor who accepts assignment. You can use the Medicare.gov Physician Compare tool to find a participating doctor in your area.

If you are enrolled in a Medicare Advantage plan, you may have to visit providers within the plan’s network. If you need help finding a plan that allows you to see your preferred doctor or help you find a plan with providers in your area, you can talk to us. With Medicare Benefits Solutions, we can help you choose a Medicare Advantage plan that works with a doctor or provider network near you.

Why is it Important to Find a Doctor Who Accepts My Medicare Plan?

Simply put, visiting doctors who don’t accept your Medicare Advantage plan or participate in your plan’s network will likely cost you more money. Depending on the type of plan you are enrolled in, you may have to visit certain doctors within a network of providers or risk paying for your services out-of-pocket. Some plans will allow you to visit doctors outside the network for a higher cost. Visiting doctors in your plan’s provider network will save you money, generally.

Depending on the Medicare Advantage plan, you may be given a directory of providers for you to choose from. If you already have a preferred doctor you’d like to continue working with, you can ask your provider’s office which plans they are contracted with.

If you are new to Medicare, we can help you enroll. And if you’re already enrolled in Medicare, we can help you switch plans during an enrollment period when you are ready. You deserve to have a doctor you trust at a price you can afford.

Prescription Drug Plans (PDPs)

Original Medicare and Medigap do NOT include coverage for prescription drugs, so many Medicare recipients choose to enroll in a Prescription Drug Plan when they are first eligible to avoid late enrollment penalties. PDPs are sold by private insurance companies, and plans can vary in cost and coverage. Each plan can have its own formulary, or list of covered drugs, and different tiers of pricing.

What Is A Provider Networks?

A provider network consists of doctors, specialists, and hospitals. These provider networks contract with plans to provide care to the plan’s members. The benefit of a provider network is, typically, lower costs for you. There are two different provider networks that you should be familiar with:

  • HMO (Health Maintenance Organization) plans usually have a select list of in-network providers. If you  go out of network, you will have higher costs or may even have to pay 100% of your costs
  • PPO (Preferred Provider Organization) plans may allow you to see doctors out-of-network for a higher cost. But due to the greater flexibility offered, PPO plans usually have higher premiums and/or copays than HMOs, generally.

Let’s talk about finding a doctor for different Medicare options.

Finding a Doctor

It will benefit you in the long run to check if your preferred doctors and specialists work with Original Medicare or your Medicare Advantage plan. You can save money long-term by having access to a doctor you trust. If you need help finding a Medicare Advantage plan that works with a certain provider or provider network near you, we’d love to support you.

Let us know how we can help by calling a licensed sales agent at (866) 576-2956 or TTY 711.

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