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The choice of which doctor you can see depends on your Medicare coverage. If you have Original Medicare (Parts A and B), you can see any doctor who accepts Medicare. Most Medicare Advantage plans have provider networks and some plans may require referrals to specialists.
Maintaining Original Medicare gives you the opportunity to decide which doctors to see, not need referrals for specialists or authorizations for procedures, in short, you are in control of your health care. But it is necessary to keep in mind that Original Medicare works as an 80/20 plan where Medicare pays only the 80% of the medical and hospital services.
That out-of-pocket 20% has no limits, so you need to purchase a Medigap policy that helps you with the costs of 20% in exchange for a monthly premium that will depend on your age, gender and area where you live. Visit our YouTube channel Avila Medicare Solutions to see videos related to this type of policy.
With respect to Medicare Part C or Advantage, these are generally classified as either HMOs or PPOs. In HMO plans, you must receive health care and services from providers in the plan's network, except:
In some plans, you can go out-of-network for some services, but it will usually cost less if you receive care from a network provider. This is called an HMO with a point-of-service (POS) option.
In most cases, you can get health care from any doctor, other health care providers, or hospitals in PPO plans. PPO plans have doctors, other health care providers, and hospitals that belong to a network.
Each plan offers you the option of going to doctors, specialists or hospitals that are not on the plan's list, but it will usually cost less if you receive care from a network provider.
In short, you visit any doctor nationwide who accepts medicare without referrals for specialists while maintaining Original Medicare (Parts A and B) but remember, you need a supplemental or Medigap policy to help you pay for 20% out-of-pocket. And you will need to be sure of the doctors you see when you have an Advantage HMO plan. With the PPO you have more options to go out-of-network, at a higher cost.
Want to review Advantage plans in your area?
Want a Medigap plan quote, please call 512-520-5957 or you can call us on our toll free number which is 855-GO-AVILA. We are here to serve you.