Can I show my Original Medicare Card instead of my Medicare Advantage card, if my provider doesn't take my advantage insurance?
Answered by 30 licensed agents
No, you cannot use your Original Medicare card if you're enrolled in a Medicare Advantage plan.
When You’re on a Medicare Advantage Plan (Part C):
Your Medicare Advantage plan takes the place of Original Medicare for your medical and hospital coverage.
You must show your Medicare Advantage card when receiving care, not your red, white, and blue Medicare card.
Original Medicare will not pay for your services while you're enrolled in a Medicare Advantage plan.
If a Provider Doesn’t Accept Your Advantage Plan:
You cannot use your Original Medicare benefits to bypass the Advantage plan’s network or billing rules.
You would either need to:
Pay out of pocket, or Find a provider who is in-network or accepts your Advantage plan, or
Switch plans during an eligible enrollment period (like the Annual Enrollment Period or Special Enrollment Period if applicable).
Bottom line: If you have Medicare Advantage, that plan is your primary coverage. Your red, white, and blue card no longer applies unless you disenroll from the Advantage plan and return to Original Medicare.
No and you must stay enrolled in medicare, but you only show your medicare advantage plan card. You do need to go to the doctors in the network for your plan to pay, otherwise its out of your pocket.
You could! You may end up paying the bill. You have allowed your Medicare Advantage plan to manage your healthcare. If you want to have control over your healthcare, consider going back to Medicare and purchasing a Medicare supplement. Then, you will have control over your healthcare.
Absolutely not! Unfortunately, no one seems to have taken the time to sit with you and explain the differences between having Medicare and Medicare Advantage, and that's why agents are so vitally important before making your original choices during Open Enrollment.
When you opted to take the Medicare Advantage plans, you forfeited, or sold, your rights to original Medicare. So, although you need the Medicare Card to show that you at one time took your Part A & B, the Doctor or Facility will be billing the holder of your private MA Plan, not Medicare.
Understand the Doctor accepting the MA Plan is being paid less, and later, so the highest quality Medical facilities and doctors will not accept MA plans, and only Medicare where they are paid more and within 30 days. I would consider finding an agent during Open Enrollment in October, and seeing if switching back to Original Medicare may be better for you.
Medicare Advantage plans are thought of as "Medicare replacement plans". Medicare pays and defers your care to your carrier to "manage your care". Some Advantage plans offer out of network care, sometimes with a higher copay. Call your insurance company to inquire about out of network care. They will tell you not to show your Medicare card, only your MA/MAPD card.
No. When you signed up for your Medicare Advantage Plan you transferred your healthcare to an insurance company, you must use your Medicare Advantage card for care. You can choose from another provider that is in your network.
Great question. No you should not show your Red, White and Blue Medicare card if you are enrolled in a Medicare Advantage plan. When you are enrolled in a Medicare Advantage plan, the plan you are enrolled in is financially responsible for your claims. If you show your Medicare card and the provider bills Medicare. Medicare will deny the claim because they will recognize you are enrolled in an Advantage plan and all claims should go to that plan.
Nope. The Medicare card only confirms your having acquired Parts A & B. The Advantage plan is Part C. So, if your provider does not take your MA plan, if you insist upon seeing that doctor, you are going to pay the retail price for the treatments from that visit! What should have happened when you turned age 65, was in finding what insurance company network that preferred doctor was in?That would have eliminated the tough predicament you now find yourself in!
The answer to that is no. When you enroll in a Medicare Advantage plan that replaces original Medicare and that is no longer the payee for your coverage. If you do show your Medicare card it will be denied. You should always make sure your doctors are in network for your plan. If you go to a provider out of network you may incur additional costs. You can either change plans to one your doctor accepts or you can choose to change doctors.
No. When you have a Medicare Advantage all your PART A AND B are under the plan. When you have an advantage plan only thing covered is hospice Part A and not covered by an Advantage Plan.
There may be some providers that will try to just bill Medicare if they don’t take your advantage plan. However this will be at the discretion of the provider. If they do this then you can expect your co-insurance to be 20% of the cost to see that specific provider.
No. When you have an Advantage Plan, that is your Primary insurance and Original Medicare moved to the back burner. The doctors you see will need to be in-network with your chosen plan. If you have a PPO Medicare Advantage you will have access to in and out of network doctors, but the office will need to be willing to bill a PPO out of network. You may also have higher co-pays for seeing an out of network doctor.
Luckily the Medicare Advantage networks are very large and continue to grow, so my clients usually do not run into these issues.
No, if you have a Medicare Advantage plan, you cannot use your Original Medicare card to get services. You must use the membership card provided by your Medicare Advantage plan. If your provider doesn't accept your Medicare Advantage plan, you will need to find a provider who does or, if you are eligible, switch back to Original Medicare.
Elaboration:
Medicare Advantage and Original Medicare:
Medicare Advantage is an alternative to Original Medicare, offering coverage through private insurance companies.
Using the Correct Card:
When you have a Medicare Advantage plan, you use the card provided by your plan to access covered services, not your Original Medicare card.
Provider Networks:
Medicare Advantage plans often have a network of providers, and you typically need to use those providers to get services.
Switches to Original Medicare:
If your provider doesn't accept your Medicare Advantage plan, you may need to switch back to Original Medicare or find another provider.
Enrollment Periods:
You can switch back to Original Medicare during specific enrollment periods, such as the Annual Enrollment Period (October 15 to December 7) and the Medicare Advantage Open Enrollment Period (January 1 to March 31).
When enrolled in a Medicare Advantage plan, you will receive your Part A and Part B benefits through your Medicare Advantage plan except for hospice care which you will continue to receive through Part A.
Original Medicare has no liability to pay any claims if you are on a Medicare Advantage Plan. Medicare pays a flat rate to the Medicare Advantage Plan carrier to manage your care and the carrier is responsible for paying your providers NOT MEDICARE itself.
No. When you're enrolled in a Medicare Advantage plan, original Medicare is no longer handling your claims. The provider you visit must be in network or you will be responsible for possibly the total cost depending if you have an HMO or PPO plan. With an HMO you must always be in network except for emergencies. With a PPO plan you can visit our ot newwork providers under 3 conditions: #1 that provider accepts Medicare. #2 that provider is willing to accept the terms and conditions of your PPO. And #3 that provider is accepting new patients.
Once you have chosen a Medicare Advantage plan, all billing goes to the plan. Original Medicare will not pay claims. Think of it like this. If a man sells a car to another man, who then sells it to another, the first is not responsible for any terms agreed to by the other two.
If you are enroll in Medicare Advantage, won't automatically guarantee coverage under Original Medicare and can lead to you being responsible for the full cost of the services.
Yes, you can use your Original Medicare card to get covered services if your provider doesn’t accept your Medicare Advantage plan. Original Medicare (Part A and Part B) is your foundational coverage, and most providers accept it.
However, if you’re enrolled in a Medicare Advantage plan, you generally need to use that plan’s network and follow its rules to get coverage under that plan. If your provider isn’t in your Advantage plan’s network, you may have to pay more or the full cost if you use your Advantage card there.
Showing your Original Medicare card can help you get services covered outside your Advantage network, but it means you’re using Original Medicare benefits, not your Advantage plan benefits. It’s a good idea to check with your provider and your plan before your visit to understand what costs you might be responsible for.
Always show your card, it may have out of network benefits if they say they don't take your plan. Please show your medicare card as well if this is a new provider that you are seeing.
No, once you are on an Advantage plan you have to use those network doctors unless you have a PPO plan which you would then be subject to the copay percentage of that plan.
No. Once you enroll in a Medicare Advantage plan, your care is completely managed by your Advantage plan carrier. Original Medicare will no longer process your medical claims. In most cases, you will not be able to use a provider that does not accept your Advantage plan.