If you’ve made the decision to sign up for a Medicare Advantage Plan (MAPD), you’ve made an important first step, but now you must find a doctor who will accept your particular plan. It is not a terribly difficult process, but it is not intuitive either.
In this blog we will discuss various plan types, and how to locate a doctor who will accept your Medicare Advantage plan.
Is Your MAPD Plan a Network Based Plan?
Not all Medicare Plans are the same, so be aware that not all plans will cover your doctor as in-network. How do you know whether your plan limits which doctor you can use? The answer is to know what type of plan you have, and to check your plan’s “Provider Directory.” Incidentally, it is not a good practice to call your doctor’s office to ask them “Do you accept my plan.” Many doctor’s office staff will simply say, “Yes, we bill everyone.” Keep in mind “we bill everyone” is NOT the same answer as being in-network. Remember, seeing a doctor that is out-of-network can you cost you more than being in-network.
Bear in mind that with any plan discussed below emergency scenarios will always be covered.
Common Types of Medicare Advantage Plans (MAPD)
It’s important to understand the different types of MAPD plans. Here’s a quick list of common plans:
Health Maintenance Organizations (HMOs): The premium costs for these Medicare plans tend to be lower, but you are typically limited to the doctors in the plan’s provider network. You’ll need to select a primary care physician (PCP). If you visit an out-of-network provider (assuming the visit was not authorized or due to an emergency) you may be responsible for 100% of the cost. Most plans offer some prescriptions drug coverage.
Preferred Provider Organizations (PPOs): You can select a doctor outside your network, and you are not required to select a PCP when you enroll. This type of plan allows you to see doctors in and out-of-network. Out-of-network providers tend to come with higher out of pocket expenses. Most plans offer some prescriptions drug coverage.
HMO-Point of Service (HMO-POS): With these Medicare Advantage Plans, your selection of doctors may be open to out-of-network choices, but you may pay higher costs. We advise clients to stay in network to attain lower co-pays but this product does have out-of-network coverage. These plans tend to come with Part D Rx coverage as well.
Provider Fee-for-Service (PFFS): These plans are not as common as they were years ago. They do not have a network, but Medicare beneficiaries must use providers who are willing to accept the plans payments, terms and conditions. Some PFFS plans offer prescriptions drug coverage.
While these types are not an exhaustive list, they do offer an overview of options for MAPD plans.
Does My Doctor Accept My Medicare Advantage Plan?
Now that you know the types of plans, how do you find the plan that will support your preference for a doctor or medical provider? Here are a few tips.
- Check out the Medicare plans website. All plans have an online provider search tool.
- Call Member Services. This “800” number will be on the back of your ID card.
- Call your agent! Your agent will have access to your plans provider directory and will be happy to help.
As a reminder, we do not suggest calling your doctor’s office to determine “Are you in-network?” Each insurance company may have multiple health plans with different networks. A doctor’s office support team may not have the up to date information on provider networks to answer your question correctly.
Where Can You Get Help to Find a Doctor?
Our goal at Blue Goose is to assist you in finding a Medicare plan that will meet your doctor requirements. We offer local support and personalized services to help you understand what your options are. We want to make sure you feel confident that you are heading down the right path that will offer the best insurance solutions no matter what your health needs may be.
Call us today at 207-807-2272 or set up a consultation now!