Is My Doctor in My Medicare Plan Network? What If My Doctor Is Not in the Network?
To avoid paying higher costs, it’s a good idea to make sure your doctor is a participating Medicare doctor and, if applicable, in your Medicare plan’s network.
If you have Original Medicare, Part A and Part B, you can usually choose any doctor that is enrolled in Medicare. To find out if your doctor accepts Medicare assignment, you can do either of these:
- Call the doctor and ask.
- Use Medicare.gov’s Physician Compare tool. The finder tool lets you search through a list of physicians in your area to see which ones accept Medicare.
Medicare Advantage plans
Instead of receiving your benefits through Original Medicare, perhaps you opted for Medicare Advantage, also known as Medicare Part C. There are several different types of Medicare Advantage plans, but all of them are available from private, Medicare-approved insurance companies, and cover your Medicare Part A and Part B benefits. Hospice care is the only exception; Medicare Part A still covers this care if you’re enrolled in a Medicare Advantage plan. Many plans include additional benefits, such as prescription drug coverage and wellness programs. You still pay a monthly premium for Medicare Part B along with any premium the Medicare Advantage plan charges.
If you belong to a Medicare Advantage plan — for example, if it’s a Health Maintenance Organization (HMO) — the plan might have required you to choose a primary care physician from a list of doctors in the plan’s network. 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 you did not have to choose a primary care physician when you enrolled in your Medicare Advantage plan — for example, if you are in a Preferred Provider Organization (PPO) — you can check with your plan provider to see if your doctor of choice is in the network.
In situations where your doctor is not in the plan’s network, you might need to change to a doctor who is in the network, or change Medicare Advantage plans. There are certain times when you can sign up for, or switch, Medicare Advantage plans.
In any case, it’s always a good idea to check with your doctor before any appointment to make sure he or she is still in the Medicare Advantage plan. If he or she is not in the plan, you might have to pay for services.
When you’re ready to compare plans and get quotes, you can use the simple form on this page to view the Medicare Advantage plan options in your area. Simply enter your zip code and then choose the sort of Medicare plan you are shopping for (such as Medicare Advantage) to see a list of what’s available near you.
Can I change my primary care provider?
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.