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What to Look for in a Medicare Healthcare Provider


If you’re new to Medicare or are approaching your eligibility date, you may be wondering if you can keep the physician you’ve had up to this point.

The answer is yes – IF he or she is participating in the Medicare program and accepting new Medicare patients. Some providers will not accept Medicare, though, and if you continue to see them, you will have to pay completely out of pocket for office visits.

Medicare HealthcareProvider/Primary Care Providers

In the Medicare world, doctors generally fall into two groups: primary care provider, or PCP, and specialists.

As the name implies, you go to a primary care provider for regular checkups and when a health problem first arises. Depending on the issue, your PCP may refer you to a specialist, who has experience diagnosing and treating specific conditions and diseases.

Do They Accept Original Medicare or Medicare Advantage?

If your goal is to keep your current PCP, you need to determine if they take one or both of the following: Original Medicare (Part A and Part B) and Medicare Advantage (Part C), which is private insurance approved by Medicare.

With an MA plan, you need to determine if the provider is in-network, as this will impact how much of the cost it will cover, and how much you’ll have to pay.

Should you need to switch doctors, in addition to whether they take new Medicare patients or MA patients, you’ll want to find out how easy it is (or isn’t) to make an appointment. Also, you may want to ensure the practitioner you choose is affiliated with the hospitals and/or outpatient facilities you prefer to use.

How Do I Find a Specialist Accepting Medicare?

You can use the above-mentioned physician comparison tool to find specialists in a variety of areas. It’s possible to search using a keyword, a specialty, a provider name, or group practice.

In general, if you have Original Medicare, you won’t be required to get a referral to see a specialist.  

What Will I Have to Pay a Specialist?

With Medicare Part B, which covers doctor visits and some in-patient (Part A) hospital doctor services, you’ll pay 20% of the Medicare approved amount for the majority of services offered. A deductible applies.

Other factors that will impact how much you pay for specialist care include how much your provider charges, the kind of facility they’re in, and where you actually get your test(s) or service(s).

You Don’t Have to Figure This Out Alone We hope this has helped you understand how primary care and specialist care works with Medicare. But if you have any questions, please feel free to contact us. Our experts will be happy to guide you through the process.

Learn More: Coordinating Medicare and COBRA

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Meet Melissa MacCalla

Medicare is not simple and can be hard, frustrating, and downright confusing for most. I love when I get someone on the phone and I am given the opportunity to explain the difference in plans to them and have Medicare make sense. I enjoy talking to clients year after year, hearing about their families growing or them asking about mine.


Oh my gosh!! I was so confused about the Medicare Supplement process. I am turning 65 soon and am retired and have always had insurance thru my former employer. I didn’t know a thing about going on Medicare and was struggling to sort it all out.

A friend of mine recommended contacting Senior HealthCare Solutions, so I did. Melissa was FANTASTIC!! She was professional, responsive, caring and friendly. She explained the steps I needed to take, gathered my information, helped me choose good plans for MY specific needs and took care of my applications over the phone. 1-2-3, eesy-peesy and I was done!! And it didn’t cost me a DIME!!! WOW!!! I HIGHLY recommend Senior Healthcare Solutions for anyone who’s overwhelmed with making the right choices with Medicare Supplemental Insurance and Rx coverage. It’ll take a load off your mind!

Janice W.

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