One of the most common concerns when transitioning to Medicare is whether you can continue seeing your current doctors. Maintaining relationships with trusted healthcare providers is important for continuity of care, but whether you can keep your doctors depends on the type of Medicare coverage you choose and whether your providers accept it. Here’s a comprehensive guide to help you understand your options.
Exploring Your Medicare Options
As you approach age 65 or prepare to embrace retirement, Medicare enrollment becomes an important step. Medicare is a federal health program designed to provide essential healthcare coverage for individuals 65 and older, as well as those with certain disabilities. If you or your spouse do not have coverage through a group health plan at work with 20 or more members, transitioning to Medicare at age 65 is typically required.
When transitioning to Medicare, you have two main options for utilizing your benefits:
- Original Medicare (Parts A and B):
In this option, Medicare serves as your primary payer. Many people choose to pair Original Medicare with a Medigap (Medicare Supplement) policy to help cover out-of-pocket costs like deductibles, copayments, and coinsurance—commonly referred to as the “gaps” in coverage. - Medicare Advantage (Part C):
Introduced in 2003, these plans are offered by private insurance companies as an alternative to Original Medicare. Medicare Advantage plans replace Original Medicare with coverage managed by the insurer and may include additional benefits like dental, vision, or prescription drug coverage.
Your decision between these two distinct pathways will play a critical role in determining whether you can continue seeing your current doctors after transitioning to Medicare.
Can You Keep Your Doctor?
Maintaining continuity of care with your trusted doctors is a key consideration when transitioning to Medicare. The ability to keep your doctor depends on the type of Medicare plan you choose—Original Medicare or a Medicare Advantage Plan. Here’s a breakdown to help you navigate your options.
Keeping Your Doctor with Original Medicare (Parts A and B)
If you opt for Original Medicare, often supplemented with a Medigap plan:
- No Network Restrictions: You can see any doctor or visit any hospital that accepts Medicare.
- Supplemental Plan Coverage: Providers who accept Original Medicare also accept your Medigap plan.
- Medicare Assignment: Confirm with your doctor whether they accept Medicare Assignment, meaning they agree to Medicare’s approved reimbursement rates as full payment.
Types of Medicare Providers:
- Assignment Doctors: These doctors accept Medicare’s approved reimbursement rates without additional charges.
- Non-Assignment Doctors: These providers may add up to a 15% “excess charge” to your bill, above Medicare’s standard reimbursement rate.
If your doctor does not take an assignment, you can consider a Medigap policy to cover excess charges. The options are:
- Plan F: Covers excess charges but is only available to those born before January 1, 1955.
- Plan G: Covers excess charges and is widely available for new enrollees.
Existing Doctor Relationships
Doctors who do not generally accept new Medicare patients often continue to see their long-time patients who transition to Medicare, provided there is an established relationship of trust.
Keeping Your Doctor with a Medicare Advantage Plan
Choosing a Medicare Advantage Plan (Part C) involves private insurance companies and operates differently from Original Medicare:
- Network-Based Coverage:
- Health Maintenance Organizations (HMOs): Require you to stay within a network, except in emergencies.
- Preferred Provider Organizations (PPOs): Offer more flexibility, allowing out-of-network visits at higher costs.
- Changing Networks: Providers’ contracts with insurers are renegotiated annually, which means your doctor’s participation in the plan could change year to year.
- Cost Structure: These plans typically have low or no premiums, using a pay-as-you-go model with co-pays for visits until you reach your annual out-of-pocket maximum.
Final Thoughts
To continue seeing your trusted doctors on Medicare, you must first decide which type of plan—Original Medicare or Medicare Advantage—best suits your needs. Once you’ve chosen a plan, confirm with your doctors whether they participate in your selected coverage.
While this process may require research and communication with providers, the peace of mind of maintaining care with the doctors you trust is invaluable. Healthcare decisions are personal and have long-term impacts, so carefully evaluating your options and ensuring your doctors are part of your plan is a critical step toward achieving the best possible health outcomes.
By taking the time to align your Medicare coverage with your healthcare preferences, you can secure a plan that supports your well-being and allows you to continue working with the doctors who know you best.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
