Do All Doctors Accept Medicare Advantage Plans?
Keeping your doctor when on Medicare is very important for many Medicare beneficiaries. The Secret to keeping your doctor when on Medicare is easy.
Dr. Paul Martin, MD
The doctor who delivered me also delivered my two younger brothers, my father and his brother and sister. My Grandpa Grimmond was friends with Dr. Martin and his father, a doctor, and professor at Creighton Medical school. Later, when I was a priest, Dr. Martin and his wife were parishioners of mine. When Dr. Martin retired, I didn’t see another doctor for 5 years. I had had only one all my life. When people tell me they really want to keep their doctor, I understand.
‘Will I Be Able to Keep My Doctor?’
When I meet with people, one of the first questions I get is, ‘Will I be able to keep my doctor?’ When people go on Medicare, it is no secret they want to keep their doctor. People have had multiple experiences of losing medical professionals because of network and plan restrictions. Keeping your doctor when on Medicare is really not a secret or an issue in the Omaha-Lincoln-Council Bluffs area when going on Medicare.
How Many Doctors Accept Medicare?
While some doctors out there may not take Medicare, I have not run into them around here.
On occasion, I have run into a few doctors in Lincoln who will limit the number of Medicare patients they will take, but if you are an existing patient, no problem. It is for those looking for a new doctor relationship that it may be an issue, but that isn’t so much a Medicare issue. It is a supply and demand for doctors issue.
For some of my clients in Arizona, doctor access is problematic. Not because of Medicare or Medicare Advantage but because of the limited number of doctors for the population in that area. Some doctors will not take you if you are a “snowbird.” They want to fill their patient lists with only year-round people patients.
I have clients throughout the country, and some clients move from the Omaha-Lincoln-Council Bluffs area. In other place, doctors and medical networks do not work as readily and closely as in the Omaha metro area.
The good thing about the three networks in our area is the networks have a strong relationship with Original Medicare, so the doctors and other medical professionals are required to serve Medicare beneficiaries. That is also true with the Medicare Advantage plans. The insurance companies work with the networks, and the networks really control how healthcare is delivered in the Omaha, Lincoln, and Council Bluffs areas.
Look In the Directory
The best way to ensure you will have access to the doctors you want is have your agent look them up in the Medicare directory or the Medicare Advantage plan directory. They can show you their name and details to put you at ease.
While I look up doctors in the directories to show people their medical professional is in-network, it is already no secret most of the doctors in the area are in the Medicare Advantage networks.
Ask About Medicare
Original Medicare is Medicare Part A for the hospital and Part B for the doctors and outpatient procedures. These are the building blocks of Medicare. It’s no secret doctors widely accept Original Medicare. Ask your doctor or his billing office if they accept assignment from Medicare.
With Original Medicare, people may also purchase a Medicare Supplement (or Medigap) policy. The doctor and facility will take the Medicare Supplement if they take Medicare.
Sometimes people will tell me they have never heard of a particular Medicare insurance company. Or, when talking with their doctor, he has never heard of a particular insurance company. If the company is selling Medigap policies in your state, they have conformed to that state’s insurance laws and regulations. The company will pay its portion of the Medicare-approved claims within 48 hours after Medicare sends them the bill. Medicare will pay within 30 days once the determination to pay is made. No worries.
Why Is Original Medicare Not Popular?
Medicare pays significantly less than most group health plans for the same services. This is a concern, especially as the distance between non-Medicare-related insurance and Medicare payments continues to expand. As it stands, the baby boomer population is so large, and so many medical specialties are dependent upon older patients, doctors and medical facilities continue to accept Medicare assignment.
Why Is Medicare Advantage Not Popular with Doctors?
Medicare Advantage plans are managed care. Like employer health plans, the insurance company determines payment for services. Sometimes the payments maybe even less than Original Medicare. Medicare Advantage plans direct more patients to medical professionals through its network to offset the smaller payments.
Clients will ask their medical professionals for insurance advice. Everyone has an opinion. People’s opinions are formed by their experiences. It would help if you thought about a medical professional’s first concerns regarding insurance and what are yours. On consideration, they may not be the same. The reimbursements from Original Medicare may be higher than from Medicare Advantage. The review of medical treatments by Orignal Medicare may be less intense than from an insurance company managing a Medicare Advantage plan. Those factors may determine a doctor and his office’s preferences.
Sometimes clients will tell me they asked their doctor if he was in-network. While doctors are intelligent people, they have a lot going on. They may not know all the companies with which they are contracted or not. It is far better to check the systems that keep the records, and while those will have their shortcomings, the provider directories are an excellent first place to start.
The Secret to keeping your doctor when on Medicare is to confirm that your doctors–all of your doctors–participate in Medicare and/or any particular Medicare Advantage plan you may be interested in. The insurance companies keep up-to-date provider directories that list the doctors and facilities actively credentialed with the insurance company and plan.
The Secret Is Ask Your Doctor About Medicare
Things are constantly changing. Each year doctors re-credential with Medicare plans. Their offices determine if it makes sense to continue to take Medicare assignment. The Secret to keeping your Medicare with your doctor is to make sure you check each year during the Annual Election Period October 15th–December 7th that your doctor(s) are still accepting Medicare and in-network with your plan.