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How Do I find Medicare Primary Care Doctors Near Me That I Like?

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Summary: How you choose a primary care doctor could be different if you have only basic Medicare, Medicare Supplement together with basic Medicare, or a Medicare Advantage plan.

Like most people, you probably want to find a likable, qualified, and conveniently located primary care doctor. This doctor might be the one you see most often. The best strategy for finding your doctor will depend upon the kind of Medicare insurance you have.

For instance, you will need to use somewhat different tactics when you choose a primary care doctor if you have only basic Medicare, Medicare supplement together with basic Medicare, or a Medicare Advantage plan. The kind of Medicare coverage you have might influence your search for a good primary care doctor near you:

What Original Medicare and Medicare Supplement pay for primary care doctor visits near you

Original (basic) Medicare may cover a certain percentage of your primary care doctor’s visit. After you pay the annual Part B deductible, basic Medicare typically covers doctor visits at 80 percent of the Medicare-approved amount, and you have to pay the other 20 percent.

You might also have a Medicare Supplement Insurance plan that will pay the additional 20 percent. But unless the Medicare Supplement Insurance plan specifies it pays excess charges, it will also base its share off of the amount Medicare allows.

You generally pay nothing for certain preventive services provided by your primary care doctor.

Saving money on primary care doctor visits near you

When a primary care doctor accepts Medicare Assignment, that means that he or she agrees to bill Medicare-approved amounts for various healthcare services. You can keep your costs as low as possibly by seeking out a primary care doctor who accepts Medicare Assignment. Medicare offers a handy search tool that you can use to find nearby doctors who agree to accept Medicare Assignment and bill Medicare for their share of the bill.

If you’d rather not have to limit your choice of doctors to those who will agree to charge only what Medicare allows, you can consider buying Medicare Plan F or Plan G to supplement Original Medicare. These two supplements will typically cover excess charges, or bills in excess of Medicare’s limits. This benefit can help broaden your choice of caregivers. It doesn’t just apply to first-line primary care doctors but also to specialists.

What Medicare Advantage pays for primary care doctor visits near you

You will mostly find managed care Medicare Advantage plans, like HMOs and PPOs. Other kinds of managed care plans work slightly different but still rely upon provider networks to reduce costs. Less commonly, you may also find Medicare Advantage plans that don’t use networks.

Finding a nearby primary care doctor who accepts your Medicare Advantage plan coverage could depend upon the type of plan that you have. For instance:

  • HMO (health maintenance organization): With an HMO, you will need to choose a primary care doctor or have the insurer assign one. You may need to get referrals from this doctor to visit specialists. Except for emergencies and other unique situations, you need to stay within the network to get your care covered.
  • PPO (preferred provider organization): You can look at your provider directory to choose a primary care doctor. While a PPO may cover a non-network doctor, you will probably get the best coverage by sticking to your plan’s network. You also don’t need referrals to see specialists; however, you will want to find a primary care doctor to handle routine medical needs and help manage all of your healthcare.

Original Medicare vs Medicare Advantage for finding a primary care doctor

You will mostly find managed care Medicare Advantage plans, like HMOs and PPOs that have networks or providers. Other kinds of managed care plans work slightly different but still rely upon provider networks to reduce costs. Less commonly, you may also find Medicare Advantage plans that don’t use networks.

Original Medicare and Medicare Supplement insurance plans don’t rely upon lists of network providers. You may save money if you find a primary care doctor who accepts Medicare Assignment for your primary care doctor. At least, you don’t also have to check if that doctor belongs to a plan network with Original Medicare.

Your satisfaction with Medicare may depend upon finding a plan that will help you access convenient and capable doctors. Many of you will also hope to choose coverage that will allow you to keep the primary care doctor that you may already know and trust.

To find a Medicare Advantage plan in your area, enter your ZIP code on this page.

Out-of-network/non- contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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