Do all Doctors Accept Medicare?
Do all your doctors accept Medicare?
I’ll give you two ways to answer that question in a minute.
But first, let’s question the question. Before you search for “doctors near me that accept Medicare,” let’s look at the type of plan you have.
You see, your doctor could accept Medicare, but she might not take your insurance plan. This is true even if you have a Medigap plan that “all doctors” accept.
Medicare Advantage
If you choose a network-based plan, your doctor could accept Medicare, but not take your insurance card. During any month you have an Advantage plan, you’ll only be able to access your Medicare Part A and Part B benefits through your plan.
Your doctor cannot bill through your red white and blue card. She will bill the insurer of your Advantage plan.
So, it’s important to make sure your doctors accept your Advantage plan – not Medicare – if you go decide an Advantage plan is a better choice for you. (I’ll give you two ways to check that below.)
Medicare Advantage vs Medigap
Why would you choose a plan that covers fewer doctors? Chances are, we can find a plan that cover all your doctors. So it may not matter if it covers fewer of the doctors you don’t see. Also, most Advantage plans are much less expensive than most Medicare Supplement (Medigap) Plans. And you may get benefits you cannot get through other types of plans (at least not without pay extra) like a full normal physical, dental care or hearing aids. (Not all Advantage plans cover dental or hearing aids.)
Medicare Supplement (aka Medigap) Plans
Since Medigap plans “supplement” Medicare Part A and Part B, they cover the same doctors “Original Medicare” does.
This is how it usually works. You’ll hand the person at the front desk your Medicare card. He or she will process the bill through the Medicare system. Medicare will pay the bulk of the cost of your treatment. Then your Medigap insurer will pay the rest or most of the rest.
A Medigap insurer will not make an independent decision to cover a doctor or a treatment. If the doctor is covered and Medicare approves the claim, the insurer has to follow Medicare’s lead. They then pay their percentage.
A Lot of Agent Say This, but It’s Wrong (I used to say it too 😔)
Sometimes we get lazy and say something like “Medicare Supplements cover all doctors. Medicare Advantage plans only cover doctors in their network.”
Most of the time that’s truthy enough. But both statements are wrong.
Medicare Supplements – the Truth – not the Truthy
Medicare Supplements cover all doctors who accept Medicare. That’s probably over 90% of them. (But it’s not 100%.)
But it’s truthy… Most doctors who do not accept Medicare won’t take any other insurance you’re likely to be eligible for.
Can a doctor refuse a Medicare Supplement?
Some might only take military insurance like Tricare. Some doctors are super expensive and only take cash because no insurer is willing to pay their fees. Some doctors take Medicare from their existing patients, but will not accept new patients.
When you’re ready to compare Medigap Plans and prices, please reach out to us.
Medicare Advantage Plans Do Cover Doctors (and other providers) Who Are Not in Their Network
All Advantage Plans Do this
All Advantage plans will cover your emergency medical care anywhere in the US with the normal in-network copay or cost share. Some plans extend this coverage worldwide.
If you are out of the service area, you can seek urgent care anywhere in the US with the normal in-network copay or cost share. If you are in the service area (this probably means Connecticut), you may not be covered if you go to a non-network urgent care or walk-in clinic. Many plans extend this coverage worldwide, but outside the country, you will pay a higher copay. You’ll probably pay the Emergency room copay when overseas.
Some Advantage Plans Do This
Some Advantage plans will give you out-of-network coverage. These are PPO and PPO plans. There are other plan types that have out-of-network coverage. None of these plan types are offered directly to individuals in Connecticut. (Some are offered people who get their insurance through a group plan.)
But here’s the catch. These plans don’t cover out-of-network care as well as they do in network treatment. You may have to pay a deductible for out-of-network care. You may have higher copays or coinsurance.
So, most “covered” out-of-network care isn’t really covered. At least not the small everyday stuff like doctor visits. You can expect to have most of your out-of-network hospital bill covered by a PPO or POS plan. But don’t expect reimbursement when you see an out-of-network dermatologist for one visit. You probably won’t meet your out-of-network deductible.
Most network based PPO and POS plans have an out-of-network deductible for even the small stuff like doctors visits. Your plan probably won’t have an in-network-deductible. If it does a deductible for in-network care, it’s probably limited to the big stuff like, hospitalization, surgery and dialysis.
Two ways to tell what Medicare plans your doctor takes
- Reach out to me and I’ll research the plans for you:
- Reach the plans yourself:
- Research doctors who take Medicare (and Medicare Supplements) here: www.Medicare.gov
- Research the Medicare Advantage plan networks here: www.CTMedicareTips.com/docs
Medicare Advantage vs Medigap
You may choose an Advantage after you compare Medigap plans with network-based options. Both plans have their pros and cons. You’ll have to weigh one against the other.
Which type of plan is better, isn’t as clear cut as many experts make it sound. You find there are disadvantages of Medigap plans. The same is true for Connecticut’s Advantage policies.
When you compare Medicare Advantage vs Medigap plan you’ll find Connecticut Medicare Advantage plans to be much less expensive. You’ll also see that they cover treatment and preventive care you own get from a Supplement. On the other hand a supplement will allow to see any doctor in America who takes Medicare and who is accepting new patients.
- Which is better Medicare Advantage or Medigap?
- More importantly, which is better for you?
- And which is better for you for the upcoming year?
These questions aren’t always easy to answer. This is why we offer both types of plans and will help you weigh the important differences. We can help you look at the difference that are important to you and your unique situation.
In Connecticut, you can make a new decision at least once per year. You can change plans, regardless of your medical history, at least once per year.
Insurers in most other states are allowed to hold certain pre-existing medical conditions against you. They can charge you more based on your heath history or your age. They can not do that to Connecticut residents. You’ll pay the same rate an other Medicare enrollee would assuming you select the same plan from the same insurer
The question “Do all Doctors Accept Medicare?” may be less important than whether your doctors take your insurance. When we look at Medicare Advantage vs Medigap plans, you’ll see that although Medigap plans cover more doctors, they do not cover all doctors.
