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What to Look for in a Medicare Healthcare Provider

What-to-Look-for-in-a-Medicare-Healthcare-Provider
03/01/2022
  • Medicare with Melissa

There are a few things to consider when looking for a Medicare healthcare provider. The most important factor is the provider’s experience and qualifications. Make sure the provider is licensed and has experience in providing care to Medicare patients.

Ask the provider how they will coordinate your care and what services they offer. Also, ask about their fee schedule, so you are aware of the costs upfront. Finally, be sure to check out the provider’s reviews online. This can help you avoid any potential problems in the future.

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.

Qualifications: Check the Provider’s Credentials

Medicare is a government-run healthcare program that provides coverage for seniors and those with disabilities. The program is vast and can be difficult to navigate, especially when it comes to finding a healthcare provider.

It’s important to do thorough research and make sure you choose a reputable provider. Look for board certifications, training and education, as well as any previous actions taken against the physician.

Services: What Does the Provider Offer?

Medicare consists of several parts, including hospital insurance, medical insurance, and prescription drug coverage. Medicare beneficiaries can receive care from any doctor or hospital that accepts Medicare patients.

However, not all doctors and hospitals accept Medicare patients. Therefore, it is important for beneficiaries to research the services offered by potential Medicare healthcare providers before selecting one.

Costs: What Will I Have to Spend?

It is important to understand the costs associated with Medicare before enrolling in the program. There are three main costs associated with Medicare: premiums, copays, and deductibles.

Premiums are the monthly fees you pay to have Medicare coverage. Most people will pay a standard premium for Part A and B coverage. Copays are the amount you pay out of pocket for covered medical expenses. Deductibles are the amount of money you must pay before your insurance kicks in.

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).

Convenience: How Accessible Is the Provider?

Medicare beneficiaries can choose from a variety of healthcare providers, including doctors, hospitals, and pharmacies. The Medicare website is a great resource and offers a provider directory that lists all of the healthcare providers that accept Medicare. It’s best to review a providers business hours and availability. Be sure to find out how far out they book appointments. You want to ensure that you can make an appointment in a timely manner. Also, don’t forget to choose a location that’s convenient for you.

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.  

Conclusion

Taking the time to find the best Medicare provider based on your exact needs is well worth the effort. The provider that you choose is just as important as the plan that you select, so choose wisely. Once you have the right plan and provider, you can really take charge of your healthcare.

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

People Also Read: Medicare Covers the COVID-19 Vaccine at No Cost to You

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.

-Melissa

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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