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Are you going to be eligible for Medicare soon, and you’re looking for a Medicare doctor? Perhaps your Medicare coverage has just started. In any case, you may be concerned about whether you’ll be able to go to the same doctor you’ve been seeing for years.
Is it hard to find a Medicare doctor?
Some people fear that when they enroll in Medicare, they won’t be able to find a Medicare doctor, or the doctor they’ve been going to for years won’t be a Medicare doctor. But you might be surprised.
The Kaiser Family Foundation reported in 2015 that over 90% of doctors accept Medicare assignment, although only 72% accepted new Medicare patients. The Forbes website says that the number of doctors accepting Medicare assignment actually went up between 2005 and 2012. So, your chances of finding a Medicare doctor – that is, a doctor who accepts Medicare assignment – should be fairly high.
How do I know if my doctor is a Medicare doctor?
To find out if your doctor is a Medicare doctor (accepts Medicare assignment), one way is to just call your doctor’s office and ask. Doctors sometimes decide to stop accepting Medicare assignment, so you might want to call and verify before you make an appointment. Medicare doctors who accept assignment agree to accept the Medicare-approved amount as full payment for a covered service or item, and agree not to charge you more than the appropriate copayment, coinsurance, and/or deductible amount.
Can I keep my doctor when I start Medicare?
There are a couple of situations where you won’t have to change doctors when you start getting Medicare benefits.
- Most people are automatically enrolled in Original Medicare, Part A and Part B, when they become eligible. Ask your doctor if he or she accepts Medicare assignment. If the answer is yes, you can keep seeing your doctor without worrying about paying higher out-of-pocket costs than you might if he or she didn’t accept assignment.
- If you decide to buy a Medicare Supplement plan to help with Original Medicare’s out-of-pocket costs (like copayments, coinsurance, and deductibles), in most cases you can continue seeing your doctor, as long as she or he accepts Medicare assignment. However, there’s one type of Medicare Supplement plan called a Medicare SELECT policy, which might require you to use network providers.
Some people prefer to receive their Medicare Part A and Part B benefits through a Medicare Advantage plan. Medicare Advantage plans deliver your Part A and Part B benefits (and often, Part D prescription drug benefits) in a single plan. Hospice services are still covered under Part A. Note that with a Medicare Advantage plan, you would still need to continue paying your Part B premium, as well as any premium the plan may charge.
How do I know if my Medicare doctor is part of a provider network?
If you decide to enroll in a Medicare Advantage plan or a Medicare SELECT plan that uses a provider network, your doctor might be part of that network. You can call your doctor, or your Medicare health plan, to find out. You can also contact Medicare; the contact information is at the bottom of this page.
What happens if my Medicare doctor stops accepting Medicare assignment?
If your Medicare doctor stops accepting assignment – or if you prefer to visit a provider even though she or he never has accepted Medicare assignment – there’s nothing to stop you from using that provider. Be aware, however, that when your doctor doesn’t take Medicare assignment:
- You might pay higher out-of-pocket costs. Providers may be allowed to charge up to 15% above Medicare-approved amounts of certain covered services. This “limiting charge” doesn’t apply to some items and services, so you may have to pay the full cost in some situations.
- The provider might require you to pay in full at the time you receive medical services.
- Although the provider generally submits a claim to Medicare for covered services, in some cases you might have to submit a claim. The provider is not allowed to charge you for submitting the claim.
The purpose of this communication is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.
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