I Don’t Like My Medicare Provider: What Should I Do?
There may be many reasons to change Medicare providers. For example, maybe a doctor has great qualifications but doesn’t have bedside manner you were hoping for. Or maybe you’ve moved and the clinic where you got dialysis treatments is now too far away.
Here’s what to do if you’re looking to change Medicare providers.
Changing Medicare providers under Original Medicare
Original Medicare, Part A and Part B, doesn’t have provider networks. This means you can typically use any Medicare provider that accepts Medicare payment terms (assignment). Assignment means that the Medicare provider agrees to accept the Medicare-approved amount as full payment for covered services.
Changing Medicare providers under Medicare Advantage
If you’d like to change Medicare providers and are enrolled in a Medicare Advantage plan, your options could depend on the type of plan you have.
Medicare Advantage Health Maintenance Organization (HMO) plans have networks of Medicare providers. Typically must use in-network Medicare providers to be covered. In emergency situations and/or out-of-area urgent care or dialysis, you’re not restricted to a network.
HMOs require you to have a primary care provider who coordinates your care and refers you to specialists. To change your primary care doctor, choose from your plan’s list of in-network Medicare providers. You may be able to find this information on your plan’s website. You may need to notify your plan if you’re changing your primary care provider so they can update their records.
If you’re enrolled in a Medicare Special Needs Plan, you may also be required to have a primary care doctor. Contact your insurance provider if you’d like to change Medicare providers.
Medicare Advantage Preferred Provider Organizations (PPOs) don’t require primary care doctors, and you have more provider flexibility. However, keep in mind when changing Medicare providers that your costs are generally lower if you use doctors in the plan’s preferred network. So, if you’d like to use a non-network Medicare provider, you usually can, but your cost sharing may be higher.
What to think about when changing Medicare providers
Here’s what you might want to know before you switch Medicare providers:
- Is the doctor accepting new patients?
- Is the hospital or doctor’s office conveniently located? If not, do you have a reliable way to get to appointments?
- If you have Original Medicare, does the doctor accept assignment?
- If you have a Medicare Advantage plan, does it limit you to in-network Medicare providers? If so, is the doctor in your plan’s network?
What to do if your coverage doesn’t pay for your Medicare provider
If there’s a specific Medicare provider you’d like to switch to who doesn’t accept your current coverage, you have a few choices.
- You could keep seeing that doctor, but keep in mind that you’ll most likely pay for some or all of his or her services out of pocket.
- You could switch to coverage that does include the Medicare provider you want. There are set times of the year when you can make coverage changes, including the Annual Election Period and Medicare Advantage Open Enrollment Period. If you qualify for a Special Election Period, you can make certain coverage changes any time that you have a qualifying situation.
How to find plan options that cover your Medicare providers
eHealth’s plan finder tool makes it easy to explore coverage options that include your Medicare doctors. To get started, enter your zip code into the plan finder tool on this page. Then, from the search results page, simply select the “Add Doctors” feature to enter in your Medicare providers and view plan options that cover your doctors. You can look up your doctor by zip code and last name.