Finding a doctor or provider you are comfortable with is important. Your choice of a Medicare provider can affect not only the treatment you receive, but also your health care costs. Here’s an overview of how Medicare providers can influence their personal costs and how to find doctors and hospitals that accept Medicare.
How your choice of Medicare providers may affects your costs
Medicare insurance providers may include one of the following:
- Physicians (such as physicians and primary care specialists)
- Other health professionals (such as physiotherapists or occupational therapists)
- Health Clinics Medical Equipment Providers
One of the most important things you can do to keep costs low is finding doctors who take Medicare. That is, you will want to find Medicare providers who “accept the allocation to the Medicare insurance plan”. This simply means that your doctor has signed an agreement with the Medicare program to accept a certain approved amount as a full payment. You will always be responsible for your share of costs, such as deductibles, copays or co-insurance.
That’s how it works. The Medicare program negotiates certain terms of payment with physicians, hospitals and suppliers. These Medicare insurance providers charge you nothing except for the deductible amount and/or co-insurance or copaytion of the Medicare insurance plan. The amount you pay is the Medicare approved service you had.
“Participating” Medicare insurance providers have signed an agreement with Medicare to charge you only their share of costs. With participating Medicare insurance providers, you usually owe 20% of the cost of the service, while health insurance pays the remaining 80%. On the other hand, “non-participating” health insurance beneficiaries have not signed an agreement with Medicare. These doctors can charge you more than Medicare has approved.
In some states, they can charge up to 15% above the cost approved by Medicare in addition to their normal portion of the bill. With a non-participating Medicare insurance provider, you may need to pay the full cost of services in advance. In some cases, suppliers may charge you more than 15% more than the Medicare approved amount.
How to find Medicare providers
If you are enrolled in a Medicare Advantage plan, the plan may have a network of providers. Some types of plans require you to consult doctors in the network. Other types of plans allow you to see Medicare insurance providers off the network, but they may charge more cost-sharing if you do.
Learn more about Advantage Medicare plan types. If you have a doctor you like, or a friend has recommended, you can simply call your doctor’s office and ask if your doctor is taking Medicare. You can also contact CyberHealth’s licensed insurance agents and ask for help finding a Medicare insurance provider in your area. You can also go to Medicare.gov.
Can you visit any Medicare provider when you have a Medicare Supplement insurance plan?
Medicare Supplement Insurance works alongside your Medicare Insurance Part A and Part B benefits. Health supplement plans are sold by private insurance companies. Each plan of the same type has the same basic benefits. You can consult any health insurance provider with most health insurance supplement plans. A type of plan, called Medicare SELECT, may require you to use a network of providers. Learn more about Medicare Insurance Supplement plans.
You can start comparing Medicare options anytime, anywhere. All you need to do is enter your postal code on this page and follow a few simple steps. Product and service descriptions, if any, provided on these Medicare ABC websites are not intended to constitute offers to sell or request for any product or service. Not all products are available in all areas and are subject to applicable laws, rules and regulations.
Who is considered a Health Care Provider/Practitioner?
Under federal regulations, a “Medicare care provider” is defined as: medical or osteopathy physician, podiatrist, dentist, chiropractor, clinical psychologist, optometrist, nurse practitioner, midwife nurse or clinical social worker authorized by the state to perform his/her duties in the course of his or her practice, as defined in State law, or a practitioner of Christian science. A health care provider is also any provider from whom the University or the employee’s collective health plan will accept a medical certificate in support of a claim for benefits.
Is My Provider Approved by Medicare?
According to the Centers for Medicare and Medicaid Services (CMS), Medicare insurance expenditures amounted to $705.9 billion in 2017. Medicare providers are motivated to receive and maintain their Medicare insurance certification in order to be eligible to receive a portion of this significant amount as payment for their services. Being approved or certified by the Medicare plan means that the supplier has been eligible for Medicare payments. Medicare certification is a way to protect yourself as a beneficiary of health insurance and ensure the quality of your care.