Will I Have To Find A Primary Care Doctor Near Me
Not all types of Medicare coverage require a primary care doctor. If you enroll in Original Medicare , you generally dont need to choose a primary care doctor but you still may wish to. You can see any doctor who takes Medicare patients, although your out-of-pocket costs will be lower if you use a doctor who accepts Medicare assignment. Medicare assignment is an agreement that the doctor will accept the Medicare-approved amount as payment in full, and wont charge you anything besides the deductible or coinsurance, if applicable.
Medicare generally covers doctor visits in most medical settings, such as in the doctors office, in the hospital or outpatient department, in a nursing facility, or at an approved health clinic.
If you enroll in a Medicare Advantage plan, you may need to select a primary care physician. Medicare Advantage Health Maintenance Organization plans and many Special Needs Plans require each person to have a primary care doctor. Medicare Advantage Preferred Provider Organizations and Private Fee-For-Service plans typically do not require members to choose a primary care physician.
Medicare Advantage is another way to receive your Original Medicare benefits through a private insurance company. Medicare Advantage plans must cover everything that Original Medicare covers, except of hospice care, which is still covered by Medicare Part A.
How To Pick Your Pcp
- If your current PCP is a member of AmeriHealth Caritas District of Columbia’s network, you may stay with that doctor.
- If you need a PCP, you can find a doctor from our provider directory. The provider directory has the office locations, hours of operation, telephone numbers, and other information about AmeriHealth DC’s providers.
- If you have trouble choosing a PCP, refer to your enrollee handbook.
- Choose a PCP for each family member in your plan. You can also choose the same PCP for everyone in your family.
- AmeriHealth DC will send you a enrollee ID card. Your card will have your PCPs name and phone number on it.
Is The Doctor In
If you have Original Medicare, you can visit any doctor that accepts Medicare assignment. However, if you have a Medicare Advantage plan such as an HMO or PPO, you may be required to see in-network doctors to be covered. You may pay more for doctors that are out of network or not be covered at all. Also, costs that you incur for out of network doctors may not count towards your out of pocket maximum.
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Find A Family Doctor Or Nurse Practitioner
A family doctor or nurse practitioner is your primary health care provider meaning they are the person you make an appointment with when you have a new, non-emergency health concern. You can learn more about their services below.
Visits to a doctor or nurse practitioner are publicly funded meaning you dont have to pay.
Here are two options to find a family doctor or nurse practitioner who is accepting new patients:
Accessing Care: Medicaid And Chip Members
To choose a doctor or Primary Care Provider , call Superior Member Services. They can give you the name, address and phone number of a doctor or specialist. They can also help you get a provider’s:
- Professional qualifications
More information on how to choose a PCP can be found in your member handbook.
To find out which nursing facilities are in Superior’s network, you can call us at 1-877-277-9772 or search our Find a Provider online tool.
If you are a STAR Kids or STAR+PLUS member and are dual eligible, Medicare pays your doctor. That means you do not need to choose a PCP in STAR Kids or STAR+PLUS. You can keep seeing the Medicare doctor you have been seeing for your health care.
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Tip 5 Call The Doctor
Lastly, call the office of the doctor youre considering. There are basic questions that they can answer for you, including which network theyre in and whether theyre accepting new patients. How the office staff answer the call can also give you an impression of the practice and whether theyre efficient and friendly. You can also ask how long it takes to get in and see the doctor, if the office is easy to get to and if they process insurance claims.
For Healthy Indiana Plan Hoosier Healthwise Or Hoosier Care Connect Members:
Please remember that if you are enrolled in the Healthy Indiana Plan , Hoosier Healthwise, or Hoosier Care Connect, you will need to choose a Primary Medical Provider within your health plan.
If you are looking for a specialist and are in a managed health plan, you may need a referral from your PMP before Medicaid will pay for certain services. Please check with your PMP or your health plan before seeking additional services.
If you have questions, you should contact your health plan directly. You can find the phone numbers for each health plan on the Contact Us page.
Use the links on the right hand side of the screen to locate providers based upon your health plan.
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Tip 4 Do A Quality Check
If you have a list of primary care doctors that may be able to help you, its time to do a quality check. A google search can often provide information about the physicians youre considering, although its good to look at trusted sources. The Physician Compare tool is available on the Medicare website. This shows performance information scores for doctors around the country. Patient survey results are also available for selected physicians. Certification Matters is a website from the American Board of Medical Specialties, which shows whether the doctor youre considering is board certified. DocInfo, from the Federation of State Medical Boards, also has information on the licensing and background information of the nations doctors.
Tips For Finding A Primary Doctor Who Accepts Medicare Advantage
COVID-19 Update: With social distancing and stay-at-home orders, many seniors are struggling with loneliness and isolation. Weve developed a list of products that caregivers or seniors can purchase to help older adults stay happy, healthy and connected, whether they are aging in place at home or in an assisted living community.
Medicare Advantage, also known as Medicare Part C, is an excellent healthcare solution for many people. The coverage is extensive, and it often has lower costs than original Medicare. However, there are challenges for people using this type of healthcare insurance. One of the primary issues is finding in-network providers. Many insurance providers use networks of providers to keep costs down and using out-of-network providers often incurs larger out-of-pocket costs through higher co-pays. Co-payments for out-of-network physicians may also increase your yearly maximum out-of-pocket limit. Finding a primary doctor who accepts your Medicare Advantage plan is essential for keeping your costs down. This guide offers tips for finding a quality physician who accepts Medicare Advantage and is within your network.
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How Do I Find Primary Care Doctors Near Me
Your Medicare Advantage plan typically sends you a list of doctors that participate with the plan. The list usually includes not only primary care doctors, but also specialists, hospitals, pharmacies, and outpatient facilities contracted with the plan. Of course, if you have a medical emergency, you should get care from the closest appropriate provider, regardless of network.
If you enroll in a Preferred Provider Organization, or PPO, you may still get a list of doctors in your plan network. While you typically dont have to choose a primary care doctor or get your routine care from providers within the plans network, you might pay less out of pocket when you see network providers.
How Do You Know If A Doctor Takes Medicare
The Centers for Medicare and Medicaid Services website offers Physician Compare, which allows you to search for doctors accepting Medicare payments. Health care professionals names, last names or groups, medical specialties, fectious diseases, a persons parts, or an organs system can be entered in the field.
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Tip 2 Get Recommendations
Some people may not have a primary care physician or may need to find a new one due to the Medicare Advantage plan they choose. If this is you, it can be helpful to start by asking friends and family for recommendations. Its important to find a doctor you feel comfortable with and who provides high-quality service. With recommendations from people you trust, you can have a list of doctors who are likely to fit that bill. From here, it is a matter of finding out if they are in your network.
Do I Need A Primary Care Doctor If I Have Medicare Advantage
If youre enrolled in a Medicare Advantage HMO plan, you will have to select a primary care doctor within the plans network to oversee your care and refer you to specialists.
If you have a Medicare Advantage Preferred Provider Organization , you usually arent mandated to select a primary care doctor, but you do need to see network physicians to pay the lowest out-of-pocket costs.
How To Change Primary Care Physicians
You may choose to change your primary care physician for various reasons. Whether you move and require physicians closer to your new homes or you are simply unsatisfied with your current PCP, Medicaid will enable you to change PCPs at any time. The process of finding a new PCP will differ depending on the Medicaid program in which you are enrolled and any supplemental health insurance plans that may cover you. However, anyone must contact their insurance company to notify them of any recent health care changes. Although the process of changing physicians may seem overwhelming, the team at migra-medicaid-guide.mufr.techopg.com encourages you to utilize the following instructions to facilitate finding ideal PCPs.
When Is It Time To Switch To A Pcp From A Pediatrician
Getting care that is right for your age and your health is important.
When your kids are young, they see a pediatrician. This is a doctor who knows all about kids health. But when they grow up, their health needs change. That is when it is time to move to a doctor who knows about adult health. Your doctor and your health plan can help you and your child make this change. If you need help finding a new doctor, talk with your doctor or call Member Services at 1-855-463-4100.
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How Do I Choose A Primary Care Doctor
Most Medicare Advantage plans publish a directory of network providers including primary care doctors. You can often get information about the doctors credentials, areas of practice, and even patient reviews from your plans directory. If the information you want isnt available through the insurer, check the providers website to learn more about the doctor and practice.
You can also visit the Federation of State Medical Boards and search a doctor to see his credentials and find out whether there are any actions against him. Your state medical board may have additional information about any potential malpractice claims.
There are also third-party doctor review sites such as HealthGrade.com and RateMDs.com and Yelp where patients can leave reviews on primary care doctors they like or dislike.
Get Additional Help Finding A Primary Care Physician Who Accepts Your Medicare Plan
Contact a licensed insurance agent for additional help finding a primary care physician near you who accepts your Medicare plan. Find out more about the Medicare Advantage coverage options in your area by calling a licensed insurance agent at 1-800-557-6059 TTY Users: 711 24 hours a day, 7 days a week, or by requesting a free no-obligation quote on line.
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, andThe Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
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Tip : Consider Medical Needs
In addition to asking physicians basic questions, prospective patients must consider their medical needs prior to choosing a new PCP and how the physicians answers will affect the quality of care. For example, patients with chronic conditions that require regular care and support may abstain from physicians with limited schedules and hours, whereas patients with fewer health concerns may not need to prioritize physician availability. The team at migra-medicaid-guide.mufr.techopg.com recognizes the value of PCPs for maintaining good health and advises you to select physicians who offer comprehensive care.
Finding A Medicare Primary Care Doctor Near Me
You can use Medicares physician compare tool to find a primary care physician near you. Just type in your city and state and the term primary care. You will get results for doctors that are categorized as family practice, general practice internal medicine and geriatric medicine. Any one of these doctors may be able to be your primary care physician.
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Tip 1 Ask Your Current Doctor
If youre happy with your current primary care doctor, you may wish to stay with them. Keeping your current doctor means your healthcare stays consistent and youre not faced with the task of finding a new healthcare provider. If youve just become eligible for Medicare and are deciding on a Medicare Advantage plan, ask your doctors office which provider network they belong to. With this information, you may be able to choose a plan that lets you stay with your current doctor.
Does Medicare Cover A Primary Care Physician Near Me
If you have Original Medicare , Medicare Part B generally covers medically necessary services and tests you get in a doctor office including visits to your primary care physician. You generally pay 20% of the Medicare approved amount, except for certain preventive services. Because this amount is a coinsurance you wont know the actual costs until you receive the bill.
If you have Medicare Advantage, you may pay a copayment for a primary care doctor visit. A copayment is a set dollar amount, for example $10, that you pay for an office visit for a primary care doctor. A benefit of Medicare Advantage is knowing in advance what you will typically pay for a doctor visit.
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Your Primary Dental Provider
When you join AmeriHealth DC, the plan’s dental program will send you information about choosing your dentist. Your dentist is called your primary dental provider or PDP. You can call our dental services provider toll-free at 1-800-685-0615. You can also call Enrollee Services at 1-202-408-4720 or toll-free at 1-800-408-7511 for questions about how to choose or change your PDP.
Do I Have To Choose A Primary Care Doctor If I Have Original Medicare
If you are enrolled in Original Medicare, you generally dont have to choose a primary care doctor. However, its important to make sure the doctor who manages your health care accepts Medicare assignment to keep your out-of-pocket costs low.
A primary care doctor has three options for caring for Medicare patients:
- Become a participating provider, which means accepting Medicare reimbursement rates as payment in full
- Become a non-participating provider, which means accepting Medicare patients but not Medicare reimbursement rates as payment in full
- Opt out of Medicare entirely
If you see a primary care doctor who participates with Medicare, you only need to pay 20% of Medicares allowable charges once your Part B deductible is met. If you choose a non-participating primary care doctor, your provider can charge you 15% more than the Medicare reimbursement rate.
Please also note, If you have Original Medicare, Part A and Part B: With this coverage, you can go to any doctor who accepts Medicare patients. You can use the Physician Compare tool at Medicare.gov to help you find a doctor who accepts Medicare assignment. Its a good idea to call the doctors office and verify that he or she will accept new Medicare patients before you make an appointment.
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Where Can I Find A Doctor That Accepts Medicare And Medicaid
To find a doctor that accepts Medicare payments, you may want to visit the Centers for Medicare and Medicaid Services’ Physician Compare. You can search by entering a health care professionals last name or group practice name, a medical specialty, a medical condition, a body part, or an organ system. This tool will provide you with a list of professionals or group practices in the specialty and geographic area you specify, along with detailed profiles, maps and driving directions.
Please note that Physician Compare only lists professionals that accept Medicare. Although some may also accept Medicaid, it does not have information about which professionals do accept Medicaid.
Medicaid programs vary by state and each state Medicaid agency maintains their own list of professionals that accept Medicaid. For further assistance, please contact your health plan or state Medicaid agency. For more information about Medicaid, visit the Medicaid & CHIP page on Healthcare.gov.
If you have trouble accessing the Physician Compare website, please call 1-800-MEDICARE and a representative will be able to run the search for you. They can also send you a print version of the search results.
There are other directories on MedlinePlus that will help you find health professionals, services, and facilities, some of which may serve Medicare or Medicaid payments.