My mom is considering switching to a Medicare Advantage plan because her friends say it's better. She's scared of losing her current doctors. How can we check?
Answered by 39 licensed agents
Having good, reliable doctors that you trust is really important. When looking into an Advantage plan, the first thing to consider is if a doctor is "in network". When a doctor is "in network" it means that the plan will cover those visits. If a doctor is "out of network" you will not be covered by the plan. When I meet with a person, I have a system that will narrow down plans that each doctor is covered by so that we can ensure the best coverage and benefits which is unique to each individual.
When it comes to Medicare Medicare plan is important to the person who is choosing their Medicare plan for themselves not what it works for someone else. The most important thing when being on Medicare advantage plan is your doctor participate with that health plan Medicare advantage plans go from January to December with that offer this year may be different the following year so it’s important to be able to work with a Medicare agent who can help you guide through and look at different options each and every year.
One, no one should ever pick a plan because their "friends" say it's better. I cannot tell you how many people made that mistake. Medicare insurance needs are different for everyone.
Two, she should be concerned about her doctors accepting the insurance because Medicare Advantage plans are network plans. But that is why you have me as a broker to check all the networks to make sure your doctors accept the plan you may be switching to.
Assuming she has a Medicare Supplement that allows her to go to any doctor who accepts new Medicare clients, the change to a Medicare Advantage plan might limit her doctor choices.
Best if she works with an independent trusted Medicare advisor prior to signing up to find out which Medicare Advantage plans might be accepted by her current doctors.
Her friends may endanger your mother. Medicare Advantage may have authorizations, Dr networks, service areas, referrals, Etc. It's easy for any Medicare broker to check her current doctors and see if they are in network for various Medicare Advantage plans.
Great question! Part of a complete review prior to making any changes is reviewing all doctors that will be potentially important for her in the future and making sure what plan, if any, they all fit into. There may be more than 1 plan to choose from once the doctors are known. I will also review prescriptions in a similar way to make sure the plans under consideration handle all current prescriptions on the formulary.
It is important to review doctors, specialists and medical facilities within a Medicare Advantage plan as Medicare Advantage Plans operate under a network. Networks can change each year, so it is important to review your plan each year to make sure the specific plan covered doctors, specialists and medical facilities that are important.
Each Medicare Advantage plan will be different, so you will have to check the zip code where you file your taxes each year to verify the doctors are within the network. Each plan will have something along the lines of a "Find a Doctor" or "Provider Directory" option on their website to verify the doctors within the network.
Also, you can contact the doctor's office directly. However, it is important to not only check if they accept the insurance carrier, but also if they accept the plan or are within the plan's network. Some doctors may accept some plans but not others under the same insurance carrier. Perhaps, the doctors will accept HMO plans, but not PPO plans or PPO plans and not HMO plans.
Out of network costs can be costly. Some plans may cover out of network costs while others do not cover out of network costs at all.
Please reassure your mom, this is the reason to use a Licensed & Certified Insurance Agent/ Broker hear to assist her find the plan she deems best for her.
We will research her Doctors, Hospitals & prescriptions are covered and which plans cover them.
We have a computer system that compares Medicare Advantage plans for our customers. By inputting the doctors' names into the system, we can show you which plans the doctors are in-network with. It is important to note that provider networks with Medicare Advantage plans do change, but the Original Medicare program has no-network.
Every company will have a list of doctors in their network and you can look it up online. That being said I'd encourage her to stay where she is if she can afford what she is paying for a Medicare supplement.
They don't always affect everyone, but Medicare Advantage plans have a lot more prior approvals than Traditional Medicare does. A prior approval is where the doctor has to go to the insurance company to make sure they will pay for a given test, procedure, hospital stay, etc. It sometimes looks like they are more concerned with protecting their profit than protecting your health and finances.
Your insurance agent should be able to check if her doctors participate with any plan she is concerning. She should also make sure her prescriptions will be covered.
You can contact a local, licensed agent, and they will be able to tell you what plans are considered in-network with her providers. If you're not comfortable reaching out to an agent, you can visit www.Medicare.gov, where you can review plans and in-network doctors as well.
“Friends” of your mom may have her health concerns at heart but they just don’t know how Medicare truly works. Since I am presuming that she has the opposite of an Advantage plan which is a Med. Supplement plan, (also known as a Medigap policy), there are NO networks whatsoever with that so her current doctors will never change unless she has lost faith in them. I hope that she doesn’t JUST have Parts A and B, because then she has only been covered for 80% of the health charges. When one picks up their “Secondary” insurance, by the acquisition of either a Medigap or an Advantage plan, all OR some of the remaining 20% is picked up by the choice she makes! A Medigap pays ALL of that 20% but the Advantage plan picks up part of her remainder.
Part of the process of shopping for a Medicare advantage plan is to find a good agent who will check to make sure that all of your doctors are in the plan that you have chosen.
It’s far more likely her doctors are in the plan and available and more places than the current Insurance she has.
You may check with the Advantage plan she is interested in. You can access the list of physicians from the Carrier's website. This is an important step in every review of changing plans.
Tell your mom to stick to her Medicare supplement plan. Medicare advantage plans are not better. You have many, many more out-of-pocket costs. They bait you with the $0 premiums and so-called free dental which is very poor coverage along with some vision and hearing coverage and they may throw in a few other perks. What they do is they take more of your money when you get sick. So don't fall for these. If she has a supplement plan and is healthy enough, we could potentially savor some money by going with another company. Give me a call
To check if your mom can keep her doctors with a Medicare Advantage plan, you need to verify if they are in the plan's network. You can do this by contacting the plan directly, checking their website, or using Medicare's online tool. If they are not in-network, you'll need to consider whether the plan allows out-of-network care and what the costs would be.
Ask the agent. The company or your Dr’s office. If the Dr isn’t available under the new plan you might want to reconsider. Either stay with your current plan or find a different advantage plan your Dr does accept
If she switches to a PPO, she will be able to keep her doctors, but an HMO, she will need to double check to make sure that the plan accepts her doctors. Not all HMO's accept every doctor. My advice is to double check with the doctor to make sure that they accept the plan.
Unless there’s a financial reason to get a no premium or low cost MAPD plan, I would encourage her to stay on her med supp plan as all doctors accepting Medicare are in network and in an MAPD network, this may not be the case. She can call me at 7145858650 and I will help
You can go to the insurance plans website and check to see if her doctors are in network.
I would always advise to work with a broker who can check all the plans in her area. This will save you time and you will have a professional to assist you in finding the best benefits and large network of providers.
Medicare Advantage can be a very good option for insureds. If there are primary care providers or specialists that are critical to your personal care, then it's a good idea to verify that docs and facilities that you like are in network. Plans vary in network sizes. Some insurance companies have very large networks and others have less docs and coverage available. Always be very careful because even within the same insurance company, doctors and facilities in network can vary greatly.
Before switching you need to make sure that her doctors are in the new network. Every Advantage plan requires you to ise the providers in their network and you can go to the insurance company's website and use their search tool to see if her doctors are in network.
That's a great question! It's definitely important to make sure your mom can keep seeing her doctors. Give me a call, and we can check the plan's network together to see if her current doctors are included. We can also explore other options to ensure she gets the coverage she needs while keeping her preferred doctors.
As an agent, I can check the providers that are in-network with that specific plan. Each carrier also has an online search tool that allows members and prospective members to see which providers are in-network.
Each carrier has a provider tool to verify they will accept the plan. I would suggest connecting with an independent Agent, they can check across all the plans for your mom.
You can go to Medicare.gov and shop plans to view the Medicare advantage options. Once you select plan details, you’ll find the direct website for the carrier. Once their website under find a provider to search or the doctors in network. You could always verify by calling her doctors office and asking if they accept the plan. I’m available to check for you by calling 4134559882.
People often HEAR that Medicare Advantage is better because of all of the perks it has included in it but what will really matter for your mom is the doctors that she trusts being in network.
Here's how to check:
1) Get the EXACT name of the Medicare Advantage plan she's looking into
2) Go to the insurance companys provider directory (they're all online)
3) Search each of the doctors names
4) Confirm they're in the network for that specific plan and network.