If you are enrolled in Original Medicare, Part A and Part B, you can choose any doctor who accepts Medicare assignment (the maximum amount allowed for charges under the Medicare payment rules).
You can call the doctor and ask or 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.
A beneficiary enrolled in a private Medicare Advantage program is faced with more research before knowing which doctors will accept your plan because it will depend on the type of plan you are enrolled in.
It’s important to understand the differences between the types of Medicare Advantage plans.
An HMO (Health Maintenance Organization) plan allows you to see your doctor if he or she is already participating in the plan.
PPO (Preferred Provider Organization) plans cover both in and out of network providers so you can choose any doctor that accepts Medicare assignment.
PFFS (Private Fee-for-Service) plans determine how much the plan will pay providers and how much you must pay to get care. Your doctor must accept the plan’s payment terms and agree to treat you. If your doctor does not agree to those terms, then the PFFS plan will not cover any services performed by your doctor.
SNP (Special Needs Plans) cover Medicare beneficiaries living in institutions who are dual-eligible for Medicaid and Medicare and those with chronic conditions like diabetes or End Stage Renal Disease (ESRD).
HMO-POS (Health Maintenance Organization-Point of Service) plans cover both in and out-of-network services, but at different rates. You pay less out-of-pocket when you use in-network doctors, labs, hospitals, and other health providers.
MSA (Medical Savings Account) plans include both a high deductible and a bank account to help you pay the deductible. The amount deposited into your account varies from plan to plan. The money is tax-free if you use it on IRS-qualified medical expenses, which include the health plan’s deductible.
The best way to determine if you doctor accepts your Medicare plan is to call before the appointment. You can also go to the Medicare.gov website and find and compare doctors, hospitals and other providers.
