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A Step-by-Step Guide to Finding a Medicare Doctor

Nurse helping senior woman

Choosing a doctor you trust is a critical part of your healthcare. When you are enrolling in a Medicare plan, it is important to find a doctor located in your area who accepts Medicare. Depending on the type of Medicare plan you choose, you may need to choose a doctor who is enrolled in your plan’s network. You will need to do some research by asking questions and checking the provider list of the Medicare health plan you are considering.

Choose a Doctor Who Accepts Medicare

Care you receive from a doctor who does not accept Medicare will not be covered by your Medicare plan. You will have to pay significantly more out of pocket for the services you receive. When you select a provider who accepts Medicare, you know you will be charged at the negotiated, acceptable rate. If you decide to go with Original Medicare, there are no networks involved. You may receive covered care from any provider within the U.S. that accepts Medicare.

To find a doctor who accepts Medicare:

  • Go to the Centers for Medicare and Medicaid Services (CMS) website and use the tool that enables you to look up and compare doctors in your area.
  • Find and compare health and drug plans in your zip code and doctors in their networks on Medicare.gov.
  • Ask friends or family members who are enrolled in Medicare to recommend doctors who accept Medicare.
  • Check the health plan’s provider listings. Medicare Advantage Plans are provided by private insurance companies. Look under their listings under specific types of medical providers to find doctors who accept Medicare within the plan’s network.

Choose a Doctor Within Your Plan’s Provider Network

If your choice is a Medicare Advantage Plan (Medicare Part C) instead of Original Medicare, you will need to choose a doctor within your plan’s network (or choose a health plan in which your doctor is a network provider). With an HMO (Health Maintenance Organization), you must see doctors included in your health plan’s network of providers. You will need a referral from your PCP (Primary Care Physician) to see a specialist. If you have an HMO and fail to choose a PCP, the health plan will assign one to you.

With a PPO (Preferred Provider Organization) Medicare Advantage Plan, there is still a list of in-network providers, but you have the flexibility to see other doctors out of network if you choose. However, your out-of-pocket costs will be higher with out-of-network doctors. It can save you money to choose a doctor from within the plan’s network.

Enrolling in Medicare can be a complex and confusing process. After you have mastered the terminology, you will need to choose between Original Medicare and Medicare Part C (a Medicare Advantage Plan). Once that choice is made, the particularly complicated part of choosing a plan and a doctor who accepts Medicare and/or is enrolled in your plan’s network begins. Our friendly agent will be happy to help simplify and walk you through the process.

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