Which Doctors Can You Visit Under Medicare?

One of the most common questions people ask after enrolling in Medicare is whether their doctor will accept their new Medicare plan. Many believe that all doctors accept Medicare, but this isn’t entirely true. Learning which doctors you can visit in your area under Medicare can help make healthcare planning much easier.

Finding doctors under Original Medicare

If you are enrolled in Original Medicare (Medicare Parts A and B), you’re more likely to have your pick of healthcare providers. A majority of doctors across the United States accept Original Medicare, but some doctors do not. You can switch to any doctor that accepts Medicare at any time.

The easiest way to find out if your current doctor accepts Medicare is to call their office and ask. If you don’t have a primary doctor or need to search for a specialist or facility, the Centers for Medicare & Medicaid Services (CMS) offers an online search tool called Care Compare. All of the physicians you’ll find on this tool accept Medicare.

One other thing to consider is whether the doctor you visit is a “participating provider” or not. These providers “accept assignment,” meaning they accept Medicare’s approved rates. You’ll pay the standard amount for care through your deductible or coinsurance.

If a doctor is not a participating provider, they can still accept Medicare, but they might charge slightly more than Medicare’s approved rate. This may result in you paying excess charges. It’s a good idea to ask your doctor about whether they are a Medicare participating provider before your visit.

Finding doctors under Medicare Advantage plans

Individuals who are enrolled in a Medicare Advantage plan (Medicare Part C) may have a slightly different pool of doctors available to them. Doctors who accept Original Medicare may not necessarily accept your Medicare Advantage plan, or they might be considered out of your plan’s network.

The list of providers available to you will usually depend on the type of Medicare Advantage plan you have. Healthcare providers must have a contract with a Medicare Advantage plan to be part of that plan’s network.

Under a Health Maintenance Organization (HMO) plan, you’re typically given an approved list of in-network providers that participate in your specific plan. If you visit a doctor outside of this list, you may end up paying more or all of the bill.

Under a Preferred Provider Organization (PPO) plan, you may have a larger pool of providers to select from, including both in-network and out-of-network doctors. Visiting in-network providers typically reduces your out-of-pocket healthcare costs.

The providers included in your Medicare Advantage network might also change more frequently. Providers may be added or dropped from the network at any time during the year. The best way to verify whether your preferred doctor is currently part of the plan’s network is to contact that provider and ask.

If you don’t have a doctor but need to find one, PlanEnroll can help you locate in-network doctors in your area. Learn more by contacting us. We have access to a wide range of plans and our licensed insurance agents are experts at helping you get the right coverage for your needs.

PlanEnroll is a brand operated by Integrity Marketing Group, LLC and used by its affiliated licensed insurance agencies that are certified to sell Medicare products. PlanEnroll is not endorsed by the Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.