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If you’re like most people, you want a doctor with whom you feel at ease, who is familiar with you and your medical history, and whom you can trust and open up to. According to studies, having a good relationship with your doctor makes it simpler to maintain good health practices and be more successful in managing health difficulties.
But what happens if you sign up for Medicare? Will you have to look for a new physician? When it comes to transitioning from Original Medicare to a Medicare Advantage healthcare plan, the ability to keep the same doctor is a major concern for most seniors. Many people continue to receive care from their valued health care providers, but in some cases, staying with the same doctors for years is not viable. You do, however, have choices when it comes to your healthcare professionals.
If you’re wondering if you’ll be able to keep seeing your family doctor once you’ve enrolled in Medicare, here’s some information on your options and how Medicare assignment works.
Is it possible to keep your current doctor once you join Original Medicare?
If you have Medicare Part B coverage, you can see any physician or health care practitioner who accepts Medicare assignments and is currently accepting new Medicare patients. You can stick with your family’s healthcare providers if this is the case. First, inquire if you may be added as a new Medicare patient.
Healthcare providers are classified as either participating, non-participating, or opt-out by Medicare. Participants in the program are not allowed to charge extra for their medical services. They are required by law to accept only the amount permitted by Medicare. Non-participating members, on the other hand, might tack on extra fees. Any sum that exceeds the service charge set by Medicare is considered an excess charge. These guidelines were put in place by Medicare to help beneficiaries reduce their out-of-pocket expenses.
You may seek care from a non-participating physician or other healthcare providers, but you will be responsible for the extra charge and copay. You pay the entire service fee amount to the non-participating provider when you see them. Then, either you or the provider must submit a claim to Medicare for reimbursement of the permitted portion of your expenses.
A Medicare Supplement (Medigap) plan, which covers expenses not covered by Original Medicare, may be able to cover these costs.
If your healthcare providers are opt-out, that means they accept Medicare patients but do not accept Medicare reimbursement, and you must pay their full expenses out-of-pocket.
After enrolling in a Medicare Advantage (Part C) plan, can you keep your current doctor?
You may be able to maintain your doctor if you have a Medicare Part C plan, but it depends on the type of Medicare Advantage (MA) plan you have and whether or not your doctor is part of the plan’s provider network.
When your care is not an emergency, you may be obliged to use healthcare professionals who are part of your HMO’s specified network of providers. In most situations, if you visit a doctor who is not in your HMO’s network, you will be responsible for the entire bill.
If you have an HMOPOS, or health maintenance organization with a point-of-service plan, you may be able to seek medical care outside of the plan’s network of providers. You may be required to pay a higher copayment or coinsurance in some circumstances. It’s possible that you’ll need to seek permission before going.
If you have a PPO, or Preferred Provider Organization, plan, you can choose from a network of doctors, specialists, and hospitals, or you can go to any doctor, specialist, or hospital who isn’t in their network, but at a higher cost. You can also see a specialist without first obtaining a reference or authorization.
With an MA plan, the best-case scenario is that your primary care provider is already a member of the plan’s network. As a result, you’ll be able to continue using this service without issue. If you have a PPO, you can choose any doctor you choose.
You can get a list of the healthcare providers who are part of the plan’s network before enrolling in a Medicare Advantage plan. This may assist you in locating a plan that allows you to maintain your important relationship with your physician.