Can I keep seeing my current doctors if I switch to a Medicare Advantage plan, or do I have to find new ones?
Answered by 17 licensed agents
You may or may not keep your current doctor's when switching to a Medicare advantage plan. Some HMO's and PPO's have extensive networks and your doctors may all participate. If you decide on an HMO you just stay in network. PPO's allow you to go out of network though your cost may be higher.
Whether you can keep your current doctors with a Medicare Advantage plan depends on whether they participate in the plan's network and if you choose a plan that allows you to see out-of-network doctors (PPO).
You'll have to use the DR's that are part of the Medicare Advantage Plan-you can easily check with Dr's and Hospitals to see if they're part of the Medicare Advantage plan you are looking to switch to. Have you looked into Medicare Supplement/Medigap-you'd be able to see any Dr that accepts Medicare!
Medicare Advantage plans are managed care plans and have many physicians who are in network, so you will have a wide range of doctors and specialists to choose from. If you prefer to stay with your current doctor, make sure he or she is in network for the plan you select. Note: A PPO plan will allow you to see a doctor outside of the plan's network, usually at a higher co pay, however, that doctor must first agree to accept your PPO plan. It is very important to do your research and to enlist an agent who will help ensure your plan meets your specific needs.
If your doctors are considered in network on an HMO style Medicare Advantage plan, you may keep them. If you choose a PPO style Medicare Advantage plan, you may go in and out of network, but should realize that if you go out of network, the cost to see that doctor will be higher than staying in network.
It's possible you might need to change doctors. Not every doctor accepts every plan. This means, if they don't accept the plan then the doctor(s) is/are NOT IN NETWORK. With a PPO, you can go out-of network, but you will pay higher out-of-pocket costs (copays, deductibles). With an HMO, generally, the out-of-network option doesn't even exist. This means, in most cases, you would pay 100% for the medical service/appointment and your plan would pay nothing. And lastly, Medicare Advantage plans change every year. One of the consequences of this is that your current plan may not be accepted by your current doctor(s) for the following calendar year.
Should any of your current doctors be registered in the Advantage plan of your choice (during the next Annual Open Enrollment period in the fall for a 1/1/26 effective date), they are yours to retain. Though I have found that, for example, if a client has 5 doctors that they want to keep, 2 will be in one network and the rest will be in another one. At that point, you must decide which of those doctors are more important to you, whether it is the 3-doc network or the 2-doc network.
Ahhhh… but that is the true concern isn’t it! So here’s the proper answer:
Maybe!!!
Your Doctor may today accept your Medicare Advantage plan. You’d have to check with the office to see which they will accept and which they won’t, IF THEY ACCEPT THEM AT ALL!!!
The other concern is EVEN IF he/she accepts them today, with the consistent changes in the Medicare program allowances, your office may elect to NOT accept any MA plans in the future.
So if having your Doctor is a major concern, if choosing any doctor and having the complete control of your health care moving forward is important to you, and that wherever you are in the USA that you have the CHOICE OF YOUR MEDICAL PROFESSIONAL, and to have coverage at the BEST FACILITIES IN THE COUNTRY BECAUSE YOU CAN, then keep your Original Medicare and get the best Supplement plan you can.
During Open Enrollment it is the ONLY TIME you will choose your Medical coverage with NO UNDERWRITING!!! So I encourage you to get it right now!
If you work with an agent they can look up your health care providers to check in-network providers. If you are taking medications, please check to make sure they are covered and how much they would cost you.
You can keep seeing your doctor if they are in the Medicare Advantage Plan network. If your doctor is out of network and you have a HMO program you will be responsible for paying all costs. A PPO program has some flexibility where you might be able to go out of network but you will most likely pay a higher copayment for seeing an out of network provider .
Whether you can keep your current doctors depends on whether they are in the network of your new Medicare Advantage plan. With Original Medicare, you can see any doctor who accepts Medicare. However, with Medicare Advantage plans, you're typically limited to doctors within the plan's network.
Elaboration:
Original Medicare:
If you have Original Medicare (Parts A and B), you can see any doctor who accepts Medicare.
Medicare Advantage Plans:
With Medicare Advantage plans (Part C), you're generally restricted to doctors who are in the plan's network.
Checking Your Doctor's Network:
Before switching to a Medicare Advantage plan, it's crucial to confirm if your current doctors are in the network of the plan you're considering. You can do this by checking the plan's website or contacting the plan's member services.
Switching if Necessary:
If your doctor is not in the network, you may need to find a new doctor within the plan's network. You can use the plan's online directory or contact member services for assistance in finding a new doctor.
When it comes to Medicare Advantage plans, there are many different providers and usually many different plans available per provider. If you are thinking about switching plans, it's important to review the plan and make sure your doctors, specialists and medical facilities that are a must keep are available within that plans network. When researching, be very cognizant of the particular plan. For example, Doctor X may be in network with United Medicare Advantage HMO plan 1 but may be out of Network with United HMO plan 2. In addition, there are many additional options like dental and vision that can vary widely along with wide ranging co-pays and max out of pocket limits from one Medicare Advantage plan to another. When it comes to making sure you make the right decision for yourself and it's important to sit down with a professional to review your options and benefits. It's doubly important if you are seeing a primary doc or specialist that you absolutely must keep in network!
That depends if your current physician is part of the Medicare Advantage network. It's better to stay with Irigional Medicare and have a Meducare Supplement.
A: If your doctors are in the network of your new plan, you just keep them seamlessly. Depending on your new plan, you still can see them and pay a higher co-pay as an out-of-network doctor.
That depends on the doctors & the plan. Every Advantage plan has their own network of doctors. When I am trying to find an Advantage plan for someone the goal is for that plan to cover all of their RXs at the lowest cost & all current doctors are in network. Be sure the agent you see checks everything before you enroll in a plan.
