Faqs About Medicare Advantage Plans And Which Doctor You Can See

Can you continue to see your regular doctor with a new Medicare Advantage (MA) plan? If you're new to MA, take a look at what you need to know about this type of plan and your medical provider choices.

What Is an Advantage Plan?

Before you can understand which medical providers your new MA insurance covers (and which ones it might not), you need to learn more about Advantage plans. Also known as Part C, this type of plan is an alternative to Original Medicare. But this doesn't mean you can skip Part A (hospital coverage) and Part B (doctor's office/medical coverage).

MA plans are only available to people who have Parts A and B. Think of MA or Part C as a bundle plan. It will help you to pay for hospital visits and medical/doctor's office or medical clinic care. Some plans also include prescription drug coverage.

Like non-Medicare plans or private insurance, MA coverage gives you the choice between a health maintenance organization (HMO), preferred provider organization (PPO), private fee for service (PFFS), and a special needs plan (SNP). The type of plan you choose may affect which medical provider you can continue to see and who you can see in the future.

Will the Plan Cover Visits to Your Doctor?

Again, MA plans include medical clinic or doctor's office visits. But this doesn't necessarily mean your coverage includes the doctor you've seen for years. Some MA plans have in-network and out-of-network doctors, clinics, and medical centers/hospitals. If you choose an out-of-network provider, you may need to pay a higher rate for visits and services.

An Advantage HMO may limit your choices to the insurer's network. If your doctor isn't in the network, you may need to choose a new primary care physician (or PCP). A PPO plan may also have in-network and out of network doctors or providers. But if your PCP is out of network, the PPO plan may still allow you to see your existing doctor—at a higher price.

How Do You Know Which Doctor the Plan Will Pay For?

Different MA plans have different in and out-of-network PCP lists. Contact your insurer to verify whether services from your doctor are covered. If your doctor isn't a plan PCP, ask how much you'll need to pay for an out-of-network provider. It's possible the extra co-payment is lower than you expect or fits within your healthcare budget.