Also known as Medicare Part C or MA plans, Medicare Advantage plans are Medicare health plans that private Medicare-approved insurance companies offer to eligible citizens. It basically provides hospital coverage, medical coverage and, in some cases, pays for prescription medications. Some plans also cover dental, vision, health and wellness programs, and hearing. Most MA plans limit the policyholder to seek healthcare services from a specific network of hospitals, doctors, and health facilities. However, a few allow out-of-network coverage, although you may end up paying a higher coinsurance or copayment.
Types of Medical Advantage Plans That May Require a Network of Providers
The Medicare Advantage plans that may or may not limit services through a network of providers include:
Abbreviated as PFFS, this MA plan does not require policyholders to seek services within a network of providers. In other words, you can visit any doctor, hospital, or health practitioner provided they are Medicare-approved and haven’t opted out of Medicare. They must also agree to treat you and accept the terms of your PFFS plan. However, some PFFS plans require a network of providers, and hence, seeking out-of-network services may attract higher costs.
Preferred Provider Organizations (PPOs)-
These plans have a network of providers from which policyholders can seek healthcare services. Usually, seeking services from doctors, hospitals, or facilities within the network costs less. Even so, you can visit any provider outside the network provided they are Medicare-approved and don’t mind treating you. The downside of this is that you will pay higher costs for services rendered.
Health Maintenance Organizations-
In HMO plans, you’re typically restricted to seeking healthcare services from a network of providers unless you need emergency care, out-of-area dialysis, or out-of-area urgent care. These plans are generally cheaper than other MA plans, and they require you to choose a primary care physician (PCP). Out-of-network care is also acceptable in some HMO plans, although it will cost higher.
HMO Point of Service (HMO-POS)-
As the name implies, this is a Health Maintenance Organization Medicare plan with a point-of-service option. Similar to HMO, this plan requires policyholders to seek care and services from a defined list of providers as well as have a primary care physician. HMO-POS also provides out-of-network coverage for hospitalization, except for mental health issues. However, you will have to pay more for services you seek out of the network.
How to Know Which Doctors Accept Medicare Advantage Plans?
Visit the Medicare Website-
The official Medicare website has different search tools to help you find doctors and healthcare providers near you. For instance, Care Compare allows you to find and compare hospitals, nursing homes, and other healthcare facilities within your locality. You can also access a lot of information about these providers, which will help you make an informed decision.
Check the insurance provider’s website-
Given Medicare Advantage plans are issued through private Medicare-approved insurance companies, you can use the information on their website to find doctors near you. Since most Medicare Advantage plans work with network providers, you will likely find a list of approved providers under your plan on the insurer’s website.
Call the insurance company-
If you have a preferred doctor in mind, you need to find out if they are listed on the insurance provider’s network. Here, you can call the insurance company, give details of your doctor, and wait for feedback. Take note that you can also check your doctor’s name on the insurer’s website.
Consult friends and family members-
If you have loved ones who use Medicare Advantage plans within your location, you may want to find out which doctors attend to them. Also, find out how their experiences have been with their doctors in terms of attentiveness, convenience, customer service, and general care provision. If you like what you hear, then consider seeking healthcare services from them, provided they accept Medicare assignments.
Call your preferred doctor-
If you’re thinking of a certain doctor, but you aren’t sure whether they are Medicare-approved or not, simply call their office and inquire. You can also check their website or visit their office physically.
What to Do If a Doctor Does Not Take Medicare?
To pay less for treatment, it is always advisable to seek health care services from a Medicare-approved practitioner who hasn’t opted out of this program. Unfortunately, not all Medicare-approved doctors accept new patients. In case your preferred doctor doesn’t take Medicare Advantage plans, do the following to lower your costs: