Article at a glance
The first step in finding a Medicare doctor is understanding which types of providers are included in Medicare coverage.
Finding a primary care physician (PCP), otherwise known as a primary care doctor, can be tricky when there are many options of primary care doctors to choose from.
When it comes to costs, making sure a provider is in-network is crucial.
There are multiple ways a patient can find doctors near them that accept Medicare.
When it comes to finding new providers, it can be confusing for patients to know how to begin their search and uncover whether certain providers accept their Medicare plan or not. However, there’s a broad spectrum of tools made available to patients with Medicare coverage that can guide them in their search for new doctors and/or specialists.
Types of Medicare Providers
As patients age, their needs may change, and different provider types can be necessary. Medicare and Medicaid Services offer a provider finder tool to help patients narrow down what they need and where to find it. This tool assists patients in finding care providers of all different types, including nursing homes, hospitals, home health care, hospice doctors/specialists, rehabilitation facilities, dialysis facilities, and durable medical equipment suppliers.
Nursing homes are facilities for patients who have difficulty being cared for at home and need 24-hour nursing assistance.
Many hospitals are covered under Medicare (critical access, children’s hospitals, long-term care, etc.) that offer all types of services (medical, surgical, psychiatric, etc.).
Home Health Care:
There are many at-home nurses, meal programs, and other services made available to Medicare patients when it comes to home health care. At times, these services can be more cost-efficient than nursing homes or hospitals.
When a patient enters hospice care, they are likely in the final stages of a terminal/incurable illness or disease. Therefore, most hospice agencies accommodate their patients by treating them where they live, whether at an assisted living facility, etc.
Many different healthcare providers and specialists are covered under Medicare, e.g., internists, family physicians, geriatricians, psychologists, and more.
After experiencing a traumatic injury, such as a stroke, many patients need intensive rehabilitation. Inpatient and outpatient rehabilitation facilities are covered under Medicare.
When a patient’s kidneys are not functioning as correctly as they should, they begin what is known as dialysis. Medicare covers over 7,000 dialysis facilities throughout the country.
Durable Medical Equipment(DME):
Medicare covers various DMEs such as canes, wheelchairs, blood sugar meters, infusion pumps, and more. Their finder tool can assist patients in finding suppliers, cost estimates, and DME availability.
What Types of Doctors Take Medicare?
All kinds of providers are covered by Medicare insurance, such as:
Doctors of Medicine (MD)
Doctors of Osteopathic Medicine (DO)
Physician Assistants (PA)
Nurse Practitioners (NP)
Clinical Nurse Specialists
Clinical Social Workers (CSW)
Physical Therapists (PT)
Occupational Therapists (OT)
When a patient signs up for a Medicare Advantage plan, dentists, optometrists, and Ear, Nose, and Throat (ENT) specialists are also covered.
Note: If you’re confused about whether or not a provider or specialist is in-network, be sure to contact a Medicare insurance agent to discuss.
To learn more about which doctors accept Medicare, visit this source.
To find a doctor that accepts Medicare insurance near you, visit this source.
Things to Think About When Searching for a PCP
Under an Original Medicare insurance plan, patients are covered for Medicare Parts A and B. Medicare Part B provides patients with the necessary insurance coverage to visit their primary care physician and receive any appropriate medical services, tests, or screenings (this does not include prescription drugs, which is available through purchasing a Part D plan). Primary care physicians (PCP) oversee and coordinate their patients’ care to ensure they are cared for holistically.
If a patient has a Medicare Advantage plan, their insurance is further broken down into plan types, the main two being the Health Maintenance Organization (HMO) plan or the Preferred Provider Organization (PPO) plan. HMO plans require their clients to have a PCP to assist with care coordination and planning. Meanwhile, PPO plans do not require their clients to have a PCP, leaving patients with more control over their care and which providers they see.
Note: Medicare Advantage (MA) plans are provided by private insurance companies rather than the federal government, so extra Medicare benefits will vary based on the MA plan. To learn more about these plan types and their differences, visit this source.
When searching for a primary care provider (PCP), reflecting on your health care needs and goals is essential. Some guiding questions to think through include:
Where is the provider located, and how far am I willing to travel?
Is transport provided?
Is this doctor within my insurance network?
Does this provider specialize in any condition(s)?
Will this doctor be available after-hours or on weekends if necessary?
Note: For more questions and suggestions on finding a primary care physician, visit this source.
How to Change Doctors Under Medicare
If a patient has standard Medicare, they are free to see whichever doctor they choose. However, it will be more cost-effective to see a doctor who accepts Medicare, so it’s a good idea to call the provider’s office ahead of time to ensure they accept Original Medicare.
If a patient has a Medicare Advantage HMO plan, they are required to select a PCP. If they want to change who their PCP is, they must contact their insurance company and request a new provider. Once the request is accepted and the doctor is altered, the patient should receive a new insurance card in the mail reflecting the changes they made.
If a patient has a Medicare Advantage PPO plan, they are not required to have a PCP and are free to see whichever provider they choose. However, in terms of cost-efficiency and making the most of insurance benefits, patients should see a provider within their network.
How to Know if a Provider is In-Network
With Orignal Medicare insurance plans, “in-network” doctors/providers accept Medicare assignments and, therefore, will take Medicare insurance plans. However, always call your provider’s office ahead of time to ensure they accept your insurance before making your appointment.
When it comes to Medicare Part C, otherwise known as Medicare Advantage plans, a patient most likely will have an HMO or PPO plan. HMO plans provide patients with a network of providers to choose from, and in most cases, a patient’s PCP is coordinating who they see within this network. PPO plans also provide patients with a network of providers to choose from; however, patients have more freedom to select which providers they want to see. Regarding both of these plans, if a patient feels confused about whether or not a chosen provider is in-network, they should contact their insurance company or provider office. Speaking with an agent from your insurance company or calling the doctor’s office will help clarify whether the provider is in your network.
How to Find Medicare Doctors Near Me
There are multiple ways a patient can narrow their search to find a doctor who accepts Medicare in your area. Ways to know if a doctor accepts Medicare include:
Tools for Original Medicare Plans:
Using Medicare’s physician compare tool on the official United States government Medicare website.
Contacting the provider’s office to ensure they accept standard Medicare.
Tools for Medicare Advantage Plans (HMO & PPO):
Browse in-network provider options on your insurance company’s website.
Speak with a licensed insurance agent from your company to clarify if the provider is in-network.
Contact the provider’s office to clarify if they accept your Medicare Advantage insurance plan.
Which Medicare part is used for doctor visits?
Medicare Part B is used for outpatient medical care, including doctor’s visits, specific lab tests, and some medical equipment, among others.
What’s the difference between a doctor and a primary care physician?
The phrases “doctor” and “primary care physician” are often used interchangeably. However, it’s important to distinguish that certain primary care physicians are classified as types of doctors. The most common primary care physicians are general practitioners and internists—the former treating patients of all ages and the latter focusing on adult patients.