Getting your health care from doctors you know well can be reassuring, especially during your senior years. Because seniors tend to have more chronic health conditions than younger people, it’s vital that they visit their physicians consistently. Statistics show that people are more likely to make and keep, appointments when they are with doctors who are familiar to them.
Seeing a primary care physician is typically the first phase of a patient’s health care. These are the doctors who have an important role in diagnosing, treating, and preventing medical conditions from the start. Primary care physicians know their patients’ medical history, risk factors, and what medications they’re taking, so they are better able to keep them healthy by frequent monitoring of issues that can lead to more serious problems.
Because having doctors you know and trust is so important for your health care, you might be concerned about whether you can keep seeing your current health care providers when you enroll in Medicare. Here’s a look at how that works with your Medicare insurance plan.
Can you keep your doctor when you enroll in Medicare?
When you become eligible for Medicare, you have the option to choose what type of coverage you want. You can enroll in Original Medicare Part A (hospital insurance) and/or Part B (medical insurance), or you can enroll in a Medicare Advantage (Part C) plan, which is an alternative to Original Medicare Parts A and B.
The type of coverage you choose determines whether you can keep your doctor while you’re on Medicare. Here’s the breakdown:
Medicare Part B covers its share of the cost of your outpatient medical care services, medical supplies, and preventive care services if your physician or health care provider accepts Medicare assignment.
Medicare considers doctors to be any of the following medical professionals:
- A Doctor of Medicine (MD)
- A Doctor of Osteopathic Medicine (DO)
And in certain cases:
- A Doctor of Dental Surgery (DDS)
- A podiatrist
- An optometrist
- A Doctor of Chiropractic (DC)
Medicare also covers services from the following health care professionals who accept Medicare assignment:
- Physician assistants
- Nurse practitioners
- Physical therapists
- Speech language pathologists
- Occupational therapists
- Clinical social workers
- Clinical psychologists
With Original Medicare insurance, you can keep your current physician(s) and other health care providers if they accept Medicare assignment. Medicare Part B requires a monthly premium, but pays for 80 percent of the approved cost, and an annual deductible applies.
If you use health care providers who don’taccept Medicare assignment (non-participating physicians) you may pay excess charges. An excess charge is the difference between the Medicare-approved amount and the amount your doctor charges for the medical services. Medicare recipients are responsible for paying these excess charges out-of-pocket.
Medicare-participating physicians are required by federal law to accept the final Medicare-approved amount as full payment for any covered medical services you get from them.
Ask your health care providers if they accept Medicare assignment.
Medicare Advantage (Part C)
If you purchase a Medicare Advantage plan from a private insurance provider, you may be able to keep your own doctor depending on the type of plan you have.
1. HMO (Health Maintenance Organization) plans
HMOs typically ask enrollees to choose a primary care physician and use health care providers and facilities within the plan’s network of preferred providers. If your current physicians are already in your plan’s network, you can continue to use them. If not, you may have to choose someone else or risk paying entirely out-of-pocket when you visit a physician outside of your plan’s network.
HMOs allow exceptions for emergency care, out-of-area urgent care, and out-of-area dialysis.
2. PPO (Preferred Provider Organization) plans
PPOs may permit enrollees to use doctors and medical facilities outside the plan’s network, but with a higher cost to the beneficiary. If you use providers listed on the plan’s network, you have lower costs. PPOs give you the option to use your own health care providers, but if they aren’t within the network, you may pay more.
3. PFFS (Private Fee for Service) plans
PFFS plans allow beneficiaries to use any physician, etc. who accepts Medicare assignment, and the payment terms of the plan.
4. HMO POS (Health Maintenance Organization Point of Service) plans
HMO POS plans allow beneficiaries to use providers who aren’t within the plan’s network. This typically means there is a higher out-of-pocket cost.
Before enrolling in a Medicare Part C plan, ask prospective insurance providers for a list of their network providers, so you can make an informed decision.