Will My Doctor Take It?
By Elie Harriett
April 15, 2016
One of the most common things we get asked by clients and potential clients alike is that all-important question, “will my doctor take this insurance?” How we treat that question is determined by the type of insurance you have. Here’s what you need to know.
If you have a Medicare Supplement: the answer is extremely simple. If the doctor takes Medicare Parts A & B (the technical word for doctors accepting Medicare is “deeming”) then the answer is yes, your doctor will take your Medicare Supplement. Not only that, but your supplement will work with any other doctor in the United States as long as that doctor also takes Medicare Parts A & B. This applies to anyone with a traditional Medicare Supplement from any company (note: if your card says “Medicare SELECT” on it, there there are restrictions to where you can use it).
If you have a Medicare Advantage Plan: it gets a little more complicated. First off, Medicare Advantage plans allow you to use any doctor during an emergency situation. However, when it is not an emergency, there are some rules. To understand those rules, you first need to know what kind of plan you have. It will be an HMO, POS, PPO, or PFFS. Here are the differences:
- HMO: Except in emergencies, you must use doctors within that plan’s network. Some plans require referrals from your primary care doctor to see specialists, but not all. Consult your plan or a knowledgeable insurance advisor to determine if that is a requirement on your plan. The primary care physician is assigned to you by the insurance company if you do not select one when joining.
- POS: Similar to an HMO, except you have the flexibility to see other primary care doctors than the one assigned to you.
- PPO: More flexibility in these plans. They have a network of doctors which you are expected to use for most of your care. But the plan will cover you at a reduced cost (meaning higher co-pays and higher out of pockets for you) if you go out of network.
- PFFS: this kind of plan is exclusive to the Medicare Advantage program. It has a network of doctors to choose from. However, you are free to use any doctor in the United States that agrees to accept the terms and conditions of the plan. You are expected to get this consent by the provider before seeing a non-networked doctor for treatment. Costs are usually, but not always, higher in this type of plan if you see non-networked doctors.
If you are choosing plans, keep these restrictions in mind when you are choosing which type of insurance you want. If you want more freedom of choice of doctors and hospitals, or you travel frequently, you might want to consider the supplement. If you are not concerned about the network of doctors for which you are assigned, then the HMO might be right for you.
Finally, a word about checking to see if your doctor is in a plan’s network. The final decision on whether your plan is accepted by your doctor is given by the insurance company, not your doctor. While it is okay to ask your doctor’s office about common plans the office accepts, it is very important you contact the insurance company and ask them if your doctor takes the specific plan you are considering purchasing.
Finding out your plan’s access to doctors is one of the most important things to look at when choosing insurance. And it is not an easy thing to understand. That is why we highly encourage you to contact someone knowledgeable about Medicare-related health insurance. Our agency helps people with all aspects of Medicare-related health insurance. If you live in Ohio, West Virginia, or Kentucky, feel free to ask us a question by either calling us or sending us an email to using the box to the right.
Keywords: medicare advantage, medicare supplement
