Doctors and Medicare

​The biggest concern most people have when switching to Medicare is how—and by whom—their health care services will be delivered. Will you still be able to see their same doctor? If you don’t currently have a primary care doctor, will you be able to get one under Medicare? What if you need a specialist? Will you have any say in choosing that specialist, and will the bills be covered under Medicare?

When you keep original Medicare as your primary insurance (and you may or may not choose to buy a Medicare supplement also known as a Medigap plan) – the federal government pays your doctors (they hire a contractor to do it on their behalf). A recent survey from KFF (Kaiser Family Foundation) showed that only 1% of providers nationwide do NOT accept Medicare patients.  That does not include providers that accept Medicare but not accepting new patients with Medicare.  Every three months Medicare sends out a summary notice to show you all claims presented and paid.  Learn more here.

When you choose a Medicare Advantage plan, the private insurance companies pay your doctors, hospitals, etc.  Providers have to be in the plan network and rules must be followed for your care to pay for.  Nationwide 46% of providers participate in a Medicare Advantage network.  Important questions to ask before selecting a Medicare Advantage plan are:

  • How do I find out which providers are in network?
  • How much do I pay for in network services?
  • Will my plan pay for out of network services and if so how much do I pay?
  • What rules must be followed to get care
  • What if I need covered treatment and there are no providers in my network available in my area?
  • What if my doctor stops participating in the plan’s network?
  • When can I make plan changes and what restrictions are there regarding changing?

Learn more about Medicare Supplement plans here, learn more about Medicare Advantage plans here.

No matter which way you receive your Medicare benefits (even if you have retirement health insurance, Federal Insurance, Tricare, VA, and more) we can help you and answer all of your Medicare questions.

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