Hopefully you have been fortunate enough to find a primary care physician and or a specialist or two that you really like. As you make a transition into the Medicare arena, you want to be able to keep the doctors you have been seeing in recent years. The decisions you make in regards to Medicare coverage could make a difference if you can keep you current doctors or if you might have to start looking for new ones. This article will help give some information how the different parts of Medicare and different types of secondary coverage might effect your choices of doctors in the future . . .
Is My Specialist in my Medicare Plan’s Network?
If you have a favorite medical specialist and you qualify for Medicare, can you keep that specialist? Some health plans restrict you to doctors and specialists in the plan’s network. But you still might be able to keep your specialist when you’re enrolled in Medicare – read on for details.
Specialists and Original Medicare
If you’re enrolled in Original Medicare (Part A and Part B), Medicare may cover visits to your specialist if she or he accepts Medicare assignment. That’s an agreement that the doctor will accept the Medicare-approved amount as full payment for covered services. You might have to pay a deductible and/or coinsurance or copayment amount, just as you would with most Medicare covered service.
Specialists and Medicare Supplement insurance
You might be able to buy a Medicare Supplement insurance plan to work alongside your Original Medicare coverage. Medicare Supplement (Medigap) plans are available from private health insurance companies. They’re designed to help cover your Medicare Part A and Part B out-of-pocket expenses, such as coinsurance, copayments, and deductibles.
Most Medicare Supplement plans don’t have provider networks, so you can visit any specialist that accepts Medicare assignment. There’s one type of Medicare Supplement plan, called a Medicare SELECT plan, that may require you to use doctors and specialist in the plan’s network. Even if you have a Medicare SELECT plan, it’s possible that your specialist is in the plan’s network; just call the plan or the doctor’s office and ask.
Specialists and Medicare Advantage plans
There are several types of Medicare Advantage plans. You may have to visit specialists within the plan’s network, depending on the type of plan you sign up for. Some Medicare Advantage plans may cover specialist visits outside the plan network, but charge higher coinsurance or copayments for these services.
Also, be aware that some Medicare Advantage plans let you arrange to see a specialist without a referral from your primary care provider (PCP), but other plans require you to get a referral.
How can I find out if my specialist is in a Medicare health plan’s network?
If you’re looking at Medicare health plans that have provider networks – such as some Medicare Advantage plans – here are a few ways you can find out if your specialist is in a certain plan’s network.
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- Call the plan’s customer service number, or see if the plan’s website lists network doctors (they often do).
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- Call your specialist’s office and ask if he’s in the plan’s provider network.
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- Use Medicare.com’s Find Medicare Doctors. When you find a doctor you’re interested in, call the doctor’s office to find out if s/he is in the plan’s network.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year. The provider network may change at any time. You will receive notice when necessary.
The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.
Medicare.com
If you have any questions about this subject or would like to speak to us about any of your Medicare needs in regards to Medicare supplement, Medicare Advantage or Part D prescription drug plans, I would certainly be very happy to speak with you.
I am an independent agent specializing in the senior market. My services to you will always be FREE. I would be very happy to look at your current coverage and compare it to the marketplace to make sure that you are still getting a good value.
Billy Williams
800-499-1942
