Finding the right Medicare approach for you is only one aspect of covering your healthcare needs in this stage of life. Finding Medicare providers, from primary care to specialists, is no small thing since your medical team will significantly impact the care you receive as you age.
To get you started, we’ve compiled a list of tips to help you choose the Medicare providers and specialists that are right for you:
Tip 1: Know your coverage before seeking a medical provider
Your options for finding a physician who works with your Medicare plan will begin with understanding whether you have Original Medicare with Supplement coverage or a Medicare Advantage plan and the key differences.
How to Find a Medicare Provider with Original Medicare
Suppose you have Medicare Parts A and B, also known as Original Medicare. In this case, you’ll have many options to choose a medical provider who accepts Medicare coverage. Because Medicare is a reliable payor backed by the full faith and credit of the U.S. government, most hospitals, doctors’ offices, medical practices, and other healthcare groups accept it as valid coverage.
In fact, according to the Centers for Medicare and Medicaid Services (CMS), 98 percent of medical service providers accept Medicare. That means your area’s medical services and doctors will likely work with your Original Medicare coverage. The groups most likely not to accept Medicare are private membership clinics that bill based on monthly or yearly fees to the select members that make up their clientele.
Additionally, your Original Medicare coverage won’t cover most vision, hearing, or dental visits.
How to Find a Medicare Provider with Medicare Advantage
Medicare Advantage coverage works similarly to traditional health insurance you would have had while working, where an insurance carrier directs you to their network for coverage and can decline to cover or cap payments for services from out-of-network providers. The functionality of these plans means they might include an allowance for vision, hearing, and dental services, similar to rider plans from traditional insurance plans.
Another distinctive feature of Medicare Advantage networks is that an insurer’s typical network may not be the same as their Advantage plan networks. For instance, an insurance carrier may use a particular doctor in their network. However, beneficiaries of the insurance carrier’s Medicare Advantage coverage may have a slightly different network that doesn’t include that particular doctor.
Looking out for these areas of difference can help you choose a doctor or specialist who can work with your Medicare Advantage plan.
Tip 2: Know What Medical Provider You Need
Before choosing a medical provider who accepts Medicare, consider what you need. Do you have an existing primary care physician who you respect and trust? If that’s the case, you might want to continue seeing that provider even after starting Medicare.
Even with a primary care provider, you’ll likely have other providers you’ll work with as you age. But you may need a new doctor or a specialist. Maybe you’re anticipating needing knee replacements in the future. In that case, you may want to consider how to find the best orthopedic surgeon. Or perhaps you’re curious about getting a primary care doctor better suited for your phase of life.
Knowing what kind of Medicare care provider you’re looking for is essential before you dive wholeheartedly into your search.
Tip 3: Don’t underestimate the importance of location, location, location
Where you live and how far you’re comfortable traveling will also matter since only 12 percent of physicians nationwide operate in rural areas. An orthopedic surgeon who practices in a metropolitan area two hours away may be perfect for surgery. But you likely won’t want to have to drive two hours or book a hotel to be present for a multi-week regimen of outpatient physical therapy.
If you’ve lived in the same area for decades, you’re probably reasonably aware of the small practices, hospital systems, physician groups, and other medical professional arrangements in your area. But if you’re a recent transplant or haven’t used the local medical system much, some internet research may serve you well.
So, before you hunt for a Medicare-approved physician, surgeon, or other medical practitioner, get clarity on what you expect from the practitioner you’re looking for, how often you anticipate seeing them, and what is available in your immediate and surrounding area.
Tip 4: Use the tools at your disposal to choose a Medicare doctor
Once you know what kind of medical care provider you’re looking for and in what area, use a Medicare provider list tool to select the medical professional who is right for you.
If you have Original Medicare, Medicare has a tool — Physician Compare — to help you choose your medical provider by searching for a type of care and proximity to your ZIP code. Medicare Advantage beneficiaries must contact their insurance carrier to select a medical provider from their Advantage-approved network of doctors and hospitals. While many carriers have network searches you can find online, others may require a phone call to verify in-network coverage.
Tip 5: Phone a friend about your Medicare-approved medical provider
If you’re searching for a doctor or hospital, don’t hesitate to ask friends for their recommendations. When choosing primary care physicians, this can be a great way to assess whether your intended doctor fits your values, personality, comfort level, stage of life, or other personal criteria. If you’re choosing a Medicare-compatible specialist like an orthopedic surgeon, word-of-mouth feedback can help determine what you’re looking for in expertise, care, and recovery.
In the age of the internet, “phoning a friend” may also mean searching through patient comments on medical review sites or checking with your state medical board. Online records from the state medical board can indicate a physician’s specialty but also reveal past histories of complaints or questions of conduct that may affect your decision.
Tip 6: Ask your potential Medicare provider if they accept Medicare
If you’re worried about how to find a Medicare provider in a pinch, the quickest way is to ask. This isn’t necessarily the best play for those with Medicare Advantage, thanks to the limited nature of care networks with Advantage programs. However, for those on Original Medicare, finding care may be as simple as calling a hospital or physician and asking, “Do you accept Medicare?” As stated, with 98 percent of medical service providers accepting traditional Medicare, more than nine times out of 10, the answer will be “Yes.”
Find out what to expect from Medicare physician coverage with this video:
Ready to choose a Medicare provider or specialist that’s right for you?
With these tips, you’re ready to find a Medicare-approved doctor for your needs, but if you’re still working to understand your Medicare decisions get one-on-one assistance from a guide at Medicare School. Our online resources are sure to help you choose a Medicare plan with confidence so you can enjoy a worry-free retirement. Learn the Medicare basics in our online workshop or give us a call to discuss your coverage option today!
