How Can I Find Doctors Who Accept My Medicare Advantage Plan?
Have you decided to sign up for a Medicare Advantage plan? If there’s a provider network that you’re supposed to use, you might be wondering how to find a doctor who accepts your Medicare Advantage plan. It’s not hard to do – keep reading to learn how.
How do you know if your Medicare Advantage plan limits you to network doctors?
Not every Medicare Advantage plan requires you to use doctors in its provider network, but many of them do. Some Medicare Advantage plans let you go outside the plan network, but might charge you a higher coinsurance amount or copayment.
Some types of Medicare Advantage plans that might have provider networks are listed below. Check your plan information to see details and rules about coverage, including whether you need to use only doctors who accept your Medicare Advantage plan.
What types of MA plans may require network providers?
Here’s a list of some common types of Medicare Advantage plans and whether they limit you to plan network providers.
- HMOs, or Health Maintenance Organizations, are a popular type of Medicare Advantage plan. Plan costs are sometimes lower than those of other Medicare Advantage plan types, but you’re usually limited to doctors in the plan’s provider network. You typically need to choose a primary care physician (PCP). Most plans cover certain prescription drugs. Read more about Medicare Advantage HMO plans.
- PPOs, or Preferred Provider Organizations*, might charge you less if you use doctors in the plan’s network. These plans generally let you seek care outside the plan network, but you may have to pay higher coinsurance or copayments if you do. You generally don’t need to choose a primary care physician (PCP). Most plans cover certain prescription drugs. Read more about the difference between Medicare Advantage HMO and PPO plans.
- HMO Point of Service (HMOPOS) plans generally have provider networks. You might be allowed to see out-of-network doctors for a higher cost. Most plans cover certain prescription drugs.
- PFFS, or Provider Fee-for-Service, plans may decide what to pay providers and what to charge members for certain Medicare services. You may be able to see any doctor who accepts Medicare assignment and accepts the terms of the PFFS plan. Some PFFS plans have provider networks that have agreed to always accept and treat plan members. Some PFFS plans cover prescription drugs.
There are other types of Medicare Advantage plans as well; some may have provider networks where you might need to find a doctor who accepts the Medicare Advantage plan.
How do you know which doctors accept Medicare Advantage plans?
There are a few different ways to find doctors who accept your Medicare Advantage plan. For example:
- Check your Medicare Advantage plan website, or call them by phone, to find doctors who accept the Medicare Advantage plan.
- Do you have a doctor in mind who you’d like to go to for your care? Call his or her office and ask, or search for the doctor on your plan’s website.
- If you’d like to find a doctor who accepts Medicare assignment – for example, if your plan lets you see doctors of your choice – you can use eHealth’s Find Medicare Doctors tool.
Again, check your plan information to see if you need to find a doctor in the plan’s network.
Want to compare plans right away? Click the Find Plans button on this page to get started.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.