What Medicare Providers Can I Visit?
Finding a doctor or provider you feel comfortable with is important. Your choice of Medicare provider may affect not just the treatment you receive, but your health-care costs.
Here’s an overview of how Medicare providers may affect your out-of-pocket costs and how to find doctors and hospitals that accept Medicare.
How your choice of Medicare providers may affects your costs
Medicare providers may include any of the following:
- Doctors (such as primary care doctors and specialists)
- Other health professionals (such as physical therapists or occupational therapists)
- Health-care clinics
- Medical equipment suppliers
One of the most important things you can do to keep down costs is to find doctors who take Medicare. That is, you’ll want to find Medicare providers who “accept Medicare assignment.” This simply means that your doctor has signed an agreement with the Medicare program to accept a certain approved amount as payment in full. You’ll still be responsible for your share of costs, such as deductibles, copayments, or coinsurance.
Here’s how it works. The Medicare program negotiates certain payment terms with doctors, hospitals, and suppliers. These Medicare providers don’t charge you anything more than the Medicare deductible and/or coinsurance or copayment amount. The amount you pay fits the Medicare-approved service you had.
“Participating” Medicare providers have signed an agreement with Medicare to only charge you your share of costs. With participating Medicare providers, you’ll typically owe 20% of the cost for the service, while Medicare pays for the remaining 80 percent.
“Non-participating” Medicare providers, on the other hand, haven’t signed an agreement with Medicare. These doctors may charge you more than the rate Medicare has approved. In some states they can charge up to 15% above the Medicare-approved cost, in addition to your normal share of the bill. With a non-participating Medicare provider, you may also have to pay the full cost for services up front.
In some cases, providers might be allowed to charge you more than 15% more than the Medicare-approved amount.
How to find Medicare providers
- If you sign up for a Medicare Advantage plan, the plan may have a provider network. Some kinds of plans require you to see doctors within the network. Other kinds of plans let you see out-of-network Medicare providers, but possibly charge higher cost-sharing if you do. Learn more about kinds of Medicare Advantage plans.
- If you have a doctor you like, or who a friend recommended, you can just call the doctor’s office and ask if the doctor takes Medicare.
- Or, you can reach out to eHealth’s licensed insurance agents and ask for help finding a Medicare provider in your area. You can also go to Medicare.gov.
Can you visit any Medicare provider when you have a Medicare Supplement insurance plan?
Medicare Supplement insurance works alongside your Medicare Part A and Part B benefits. Medicare Supplement plans are sold by private insurance companies. Every plan of the same type has the same basic benefits. You can visit any Medicare provider with most Medicare Supplement plans. One type of plan, called Medicare SELECT, may require you to use a provider network. Learn more about Medicare Supplement insurance plans.
You can start comparing Medicare plan options anytime, anywhere. All you need to do is enter your zip code on this page and follow a few simple steps.
The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.