When it comes to Medicare, choosing your doctors may be a little bit different than the plans you’ve had in the past. It is true that most doctors take Medicare, in fact over 800,000 doctors take Medicare.
What Percentage of Doctors Accept Medicare
That is over 91 percent of all doctors in America. Before we are on Medicare most of us are accustomed to having to use networks, deal with referrals, and making sure the specialist or facility we want to use is in the plan’s network.
Well, good news! When you go on Medicare you get a lot more freedom when it comes to choosing your doctor.
Medicare Phone Numbers for Providers
Contacting Medicare is as simple as dialing 1-800-MEDICARE. Beneficiaries can log in to the MyMedicare.gov account for information on claims and medical records.
For other questions, you can always contact Medicare.
When you are on Original Medicare you have the largest network of providers possible. If you want to utilize the best hospital in New York, the best endocrinologist in California or just Dr. Smith down the road chances are good that they are in-network.
It’s true that not all doctors accept Medicare, and there has been a lot of hype in recent years about what doctors take Medicare.
This brings many questions such as:
- Will I still be able to see my current doctor?
- Are doctors leaving the Medicare network?
- If I go on a Medicare Plan will my doctor drop me?
Medicare Doctors Fall into One of Three Categories
There are 3 categories that doctors fall into when it comes to Medicare:
- Participating Doctors accept Medicare assignment; This means the doctor accepts Medicare assignment and will only charge up to the amount that Medicare allows for services.
- Non-Participating Doctors can choose to accept or not accept Medicare assignment; This means the doctor takes Medicare but can choose to charge an excess charge. An excess charge is up 15% more than what Medicare allows for services. These doctors do not have to charge the excess, but they reserve the right to do so.
- Doctors that have Opted out of Medicare are by far the minority. These doctors do not accept Medicare at all. If you see one of these doctors they can charge whatever they want, and you are responsible for the entire bill.
How Does Having a Medicare Supplement Impact Your Network of Doctors
Having a Medicare Supplement plan does not impact your network of doctors in any way.
You may occasionally get someone behind the desk that is not as informed as they should be and try to tell you they don’t take your companies plan, this is because they have network lists regarding Medicare Advantage Plans.
Simply ask if they take Medicare and if they do they are required to take the supplement plan.
How Does Having a Medicare Advantage Plan Impact Your Doctor Network
Unlike a Medicare Supplement, a Medicare Advantage Plan replaces your Original Medicare in a sense. Your health coverage is taken over completely by the insurance company and you do not have the freedom to simply go to any doctor that accepts Medicare.
You are subject to the plan networks, and rules for referrals and services. In most cases, if you go to a Doctor that takes Original Medicare but does not take your Medicare Advantage Plan you will have to pay full cost for the service.
Some Medicare Advantage Plans do have Preferred Provider (PPO) Networks that allow you to go out of Network, however, the doctor you see does not have to accept your plans negotiated rates and you may have to pay out of pocket and get some portion reimbursed from the plan.
That and generally speaking the copays, coinsurance, deductibles, and maximum out of pockets are significantly higher when you use the out of network benefits.
Does Having Medicaid Impact Your Doctor Network
This can be a more complicated situation. If you are on Medicare and Medicaid you can always go to any doctor that accepts Original Medicare.
The best practice when dealing with Medicare and Medicaid is to make sure the provider takes both Medicare and Medicaid. This way the Medicaid plan will pay for your portion of the bill.
How To Know If Your Doctor Takes Medicare
Medicare has some tools and resources to help you in finding a doctor that participates in Medicare and accepts Medicare assignment. The most common and easiest to use is the Physician Compare tool on Medicare.gov.
It is a simple tool that allows you to search for your doctor in several ways, including name, specialty, physicians group, body part, or condition. It will provide you with the phone number, address and has a map of your area that allows you to see where exactly the doctor is located.
If you’re unable to access, Medicare.gov online platform, you can call Medicare, and their customer representative will help you find a doctor who offers Medicare around your place.