Keeping Your Trusted Doctors When You Go on Medicare: A Comprehensive Guide
Transitioning to Medicare can feel like uncharted territory, especially when trying to ensure you can continue seeing the physicians you trust. Discover the essential steps you must take to ensure that you can continue receiving care from your trusted healthcare providers as you transition to Medicare.
Understanding Your Medicare Options
As you approach the milestone age of 65 or decide it’s time to embark on a fulfilling retirement, the opportunity to enroll in Medicare may become available to you. Medicare is a valuable healthcare program specifically created to cater to the healthcare needs of individuals aged 65 and above, as well as those with disabilities. It’s important to note that if you or your spouse do not have coverage through a group plan of 20 or more individuals at your workplace, it is mandatory to transition to Medicare once you turn 65.
When transitioning to Medicare, you have two primary ways to use your benefits:
- Stay in the “original” Medicare A and B system: In this case, Medicare serves as your primary payer, and it is advisable to consider incorporating a Medigap policy, which is also referred to as a Medicare supplemental plan, to address any additional expenses or “gaps” that may arise.
- Use a replacement plan: An alternative to original Medicare, these Medicare Part C plans or Medicare Advantage Plans, which were introduced in 2003, essentially replace original Medicare with covered administered by a private insurance company.
Your choice between these two fundamentally different options will significantly impact whether you can continue to see your doctors when on Medicare.
Can You Keep Your Doctor?
Keeping Your Doctor Under the Original Medicare A and B System
When using the original Medicare A and B system with a supplemental plan;
- You have no restrictions concerning networks. You can visit any hospital or doctor that takes Medicare.
- If a provider accepts original Medicare, they must also accept your supplemental plan.
- You must always confirm with providers whether they accept Medicare Assignment, meaning they agree to Medicare’s approved reimbursement rates as payment in full.
There are two types of doctors that accept Medicare: those who participate in the fee-for-service system, referred to as “assignment doctors,” and those who do not, known as “non-assignment doctors.” Non-assignment doctors can add an “excess charge” to your bill, up to 15% above Medicare’s standard reimbursement rate.
If your doctor takes assignment, great! If not, you might consider selecting a Medigap policy that will cover any excess charges. Only two options provide this coverage: Plan F and Plan G. Plan F is being phased out, and is only available to those born before January 1, 1955. Thus, Plan G is a good option to cover excess charges if your doctor doesn’t take assignment.
It’s important to highlight that doctors who typically do not accept new Medicare patients often maintain their commitment to seeing their existing patients who transition to Medicare, as long as there is a strong foundation of trust and an established relationship in place.
Keeping Your Doctor Using an Advantage Plan
Enrolling in an Advantage Plan means signing up for private insurance plans, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), that take the place of original Medicare. When it comes to provider options, selecting an Advantage Plan can be slightly more complex:
- These plans operate within specific provider networks. An HMO requires you to stay within your designated network, except in emergencies, while a PPO offers a broader network and more flexibility to see providers outside the network.
- Each year, insurers renegotiate their contracts with providers, so your doctors’ participation in the plan can change annually.
Advantage Plans typically do not require premiums, offering a “pay-as-you-go” approach instead. This means you will only pay co-pays when you visit doctors, until you reach your maximum out-of-pocket limit for the year.
Final Words
In order to continue receiving care from your trusted doctors while on Medicare, you must first determine which type of Medicare plan you will use: original Medicare with a supplemental plan or an Advantage Plan. Once you have made this decision, it is important to verify if your doctors participate in the chosen system. While this process may require some research and reaching out to providers, the peace of mind that comes with securing your healthcare with the doctors you trust is invaluable.
Healthcare decisions are deeply personal and can have a profound impact on your life. They can shape your future and even have irreversible consequences. That’s why it’s crucial to carefully consider your coverage options when it comes to your health. Ensuring that your trusted doctors are part of the equation is essential for setting yourself up for the best possible health outcomes.
Ultimately, the goal is to find a Medicare plan that allows you to continue receiving care from your trusted doctors. By carefully considering your coverage options and verifying your doctors’ participation, you can set yourself up for the best possible health outcomes. Remember, healthcare decisions are significant, and having the right doctors in your corner can make all the difference.