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How Often Can I Switch Medicare Providers?

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Are you looking for a different Medicare doctor? There could be many reasons you might want to switch Medicare providers. Maybe your doctor is retiring, or you’re moving. Perhaps a friend highly recommends a doctor who’s familiar with your health condition. Or, maybe you’re just not comfortable with your current provider.

In any case, the rules about switching Medicare providers depend partly on what type of Medicare coverage you have. Here are the details.

How to switch Medicare providers under Original Medicare

Traditional Medicare, Part A and Part B, is pretty flexible about the doctors you can visit.  Medicare typically covers visits with any doctor who accepts Medicare assignment. That means the doctor must accept the Medicare-approved amount for the service(s) as full payment. She or he isn’t allowed to bill you for any amount other than the Medicare deductible and/or coinsurance amounts.

You generally can switch Medicare providers anytime you want, as long as the doctor accepts Medicare assignment. You may want to call the doctor’s office before your appointment to make sure he or she still accepts Medicare assignment.

In fact, even if you switch to a Medicare provider who doesn’t take Medicare assignment, it might cost you more but you’re generally protected by certain limitations.

  • If legally allowed to do so, the doctor can charge up to 15% more than the Medicare-approved amount for the service. This rule doesn’t apply to all Medicare services.
  • The doctor can’t bill you for submitting the claim to Medicare, although in some cases you might have to submit the claim.
  • You might have to pay for the entire cost of the visit at the time of service.

How to switch Medicare providers under Medicare Advantage

Do you have a Medicare Advantage plan? The steps for switching Medicare providers may depend partly on the plan’s rules and partly on the type of plan you have.

There are several different kinds of Medicare Advantage plans. Some plans, such as Health Maintenance Organizations (HMOs), have provider networks. Doctors and other health-care providers contract with the private, Medicare-approved insurance companies that offer Medicare Advantage plans.

Preferred Provider Organizations (PPOs), on the other hand, generally let you use providers outside the plan’s network. Your out-of-pocket costs, such as coinsurance or copayments, may be higher if you go out of network. These plans may give you flexibility to switch Medicare providers.

What if you want to change from one Medicare provider to another? You may be able to choose a different provider in the plan’s network (or, with some plan types, outside the network). For specific rules about switching providers, such as how often you can switch, contact your plan directly.

How to switch Medicare providers or pharmacies under Medicare Part D

Your Medicare prescription drug plan might have a preferred pharmacy network. This can be true whether you have a Medicare Advantage prescription drug plan, or a stand-alone Medicare Part D prescription drug plan.

In some cases, you may be able to order from mail-order pharmacies through your plan. Sometimes you can save money this way.

If you’re enrolled in a Medicare Advantage prescription drug plan, see the information about Medicare Advantage plans, above. If you have a stand-alone Medicare Part D prescription drug plan, be aware that your prescriber must be enrolled in Medicare, or have an “opt-out” request on file with Medicare. If neither of these is true of your prescribing doctor, usually you’ll still be able to get your prescription drugs covered for three months.

During those three months, you should find a Medicare provider to prescribe your medications who’s enrolled in Medicare or who has an opt-out request on file.

If you want to switch prescribers or pharmacies, contact your plan to find out your plan’s specific rules.

How to switch Medicare providers if you have a Medicare Supplement plan

Medicare Supplement insurance plans work alongside your basic l Medicare (Part A and Part B) coverage. These plans may help pay your Part A and Part B out-of-pocket costs, like coinsurance, copayments, and deductibles. They’re sold by private insurance companies.

Most Medicare Supplement insurance plans don’t restrict you to using certain providers. Generally the rules are the same as with Original Medicare, above. In short, you can visit any doctor or other provider who accepts Medicare assignment.

However, some Medicare Supplement plans, called Medicare SELECT plans, may require you to use providers in the plan’s network.

Which type of coverage should you choose? It might help you decide if you compare plans available in your area. Just type your zip code where indicated on this page. Then you can click Medicare Advantage plans, Medicare Supplement insurance plans, or Medicare prescription drug plans. Questions? You’re welcome to contact an eHealth licensed insurance agent.

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