Is my doctor in my Medicare plan network? What if my doctor is not in the network?

Is my doctor in my Medicare plan network? What if my doctor is not in the network?

One of the best ways to minimize health care costs is to ensure that your doctor is both a participating Medicare physician and a part of your plan's network. Below are some guidelines for finding a doctor that is in network in both the Original Medicare (Medicare Parts A and B) and Medicare Advantage (Medicare Part C) programs.

Choosing a Doctor with Original Medicare (Parts A and B)

If you are enrolled with Original Medicare, you can usually choose any Medicare-enrolled doctor. For many, the simplest way to determine if your doctor is part of the plan is to call the doctor's office and ask. The office staff are trained help.

What is Medicare Advantage (Part C)?

Some people choose to enroll in a Medicare Advantage plan, which includes Medicare Parts A and B and extends your benefits. For example, Medicare Advantage plans may include prescription drug coverage and wellness plans. Participants in a Medicare Advantage plan still pay a monthly premium for Medicare Part B in addition to a premium for Medicare Advantage. There are several types of Medicare Advantage plans and choosing doctors within each of these plans is explained in further detail below. 

Choosing a Doctor with Medicare Advantage / HMO

If you are in a Medicare Advantage HMO (Health Maintenance Organization), you likely had to choose a doctor from a provided list. If you did this, you know the doctor is a participating Medicare provider within the plan's service area. Your plan will notify you if the doctor leaves your plan. If your doctor is not a part of the plan, you may need to switch doctors or switch Medicare Advantage plans. 

Choosing a Doctor with Medicare Advantage / PPO

If you are in a Medicare Advantage PPO (Preferred Provider Organization), you likely did not have to choose a primary care physician when you enrolled. You can check with your plan provider to see if your doctor of choice is in the network. Like the HMO, if your doctor is not a part of the plan, you may need to switch doctors or switch Medicare Advantage plans. 

Switching Medicare Advantage Plans

Whether you are enrolled in a Medicare Advantage PPO or HMO plan, it is important to remember a few things when switching plans. First, compare plans and get quotes with our <link>Medicare Plan Finder<link> or visit Medicare.gov. Please note that enrollment for Medicare Advantage Plans occurs only at certain times of the year.

Switching Doctors within Medicare Advantage Plans

It's a good idea to check with your doctor before any appointment to make sure he or she is still in your Medicare Advantage plan. If your doctor is not in the plan, you might need to pay for all or a portion of the services out of pocket. In most cases it is possible for you to change primary care providers with Medicare Advantage coverage. You may want to make sure this is an option before enrolling in a plan, and use your plan's instructions for changing providers.

If you are looking for a plan that's right for you, try our Medicare Cost Revealer to compare plans and get a quote.One of the best ways to minimize health care costs is to ensure that your doctor is both a participating Medicare physician and a part of your plan's network. Below are some guidelines for finding a doctor that is in network in both the Original Medicare (Medicare Parts A and B) and Medicare Advantage (Medicare Part C) programs.

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Is my doctor in my Medicare plan network? What if my doctor is not in the network?