Can I Keep My Current Doctor When I Transition to Medicare?

The transition from private or employer-provided health insurance to Medicare is a pivotal juncture for people nearing or entering retirement. Many older Americans are understandably concerned about their continuity of care as they embark on this new life chapter.

One of the most common questions asked by people looking at Medicare is whether they can continue seeing the same doctors. This is especially important if you like and trust your doctor and don’t want to change to a provider you don’t know. 

Can You Keep Your Current Doctors?

If your doctor doesn’t accept Medicare, then no, you likely won’t be able to keep your same doctor in retirement. The good news is many doctors do accept Medicare, especially if they often treat geriatric patients (those 65 years of age and older), so you likely won’t need to change your primary care physician.

Under traditional Medicare (Parts A and B), beneficiaries have the flexibility to see any doctor or healthcare provider who accepts Medicare without the need for referrals. Original Medicare’s open network is one of the key advantages of traditional Medicare.

Medicare Advantage is a bit more complicated. Since Part A and Part B are included in any Medicare Part C plan, you will be able to continue seeing any of your previous doctors as long as they accept Medicare. Whether you can continue seeing your dentist or optometrist will depend on whether they are in your Medicare Advantage plan’s network.

Medicare Part C plans are offered by private insurance companies approved by Medicare and may have more restrictive networks compared to traditional Medicare. If you really like your current dentists or other specialists, be sure to ask them which networks they accept before you enroll in a Medicare Advantage plan.

It's important to review the specific plan details or contact the plan provider to understand the network limitations. Some doctors may only accept Medicare plans under certain conditions or may not be accepting new Medicare patients.

Beneficiaries should directly contact their doctors or use the Medicare.gov Physician Compare tool to verify if their providers are Medicare-approved.

What About Medigap?

The providers you can choose is determined by Medicare's network, not by your Medigap policy. Medigap simply helps cover some of the out-of-pocket costs associated with Medicare-covered services.

What If My Doctor Doesn’t Accept Medicare?

It may be a good idea to start doing research on doctors or specialists prior to losing your current health insurance so you don’t get an unpleasant surprise when you try to schedule an appointment after enrolling in Medicare. If you like your current doctor but they don’t accept Medicare, ask them for recommendations or referrals. They may have colleagues they trust who do accept Medicare or are in-network for your Medicare Advantage plan.

Why Is Medicare Advantage More Restrictive?

One of the goals of Original Medicare is to provide health insurance that is good almost anywhere. Medicare Advantage is more like traditional health insurance, so the networks are inherently more restrictive. That doesn’t mean it’s bad – it just means you may need to adhere to the same network restrictions as people who don’t have Medicare.

Not all Medicare Advantage plans are equal in terms of provider network composition. Some plans offer broader network access than others. Some Medicare Part C plans may also require referrals to see certain types of specialists.

Like with any other private health insurance plan, you may need to pay higher fees if you need to see an out-of-network provider.

These restrictions do not mean Medicare Part C is worse than Original Medicare – especially considering those types of specialists are likely not covered at all by Part A or B. For most retirees, a Medicare Advantage plan that’s accepted by most local specialists is the best solution for health insurance.

Get Help With Medicare Planning and Choosing the Right Medicare Advantage or Medigap Coverage

Medicare may seem deceptively straightforward as you near retirement age. It’s a free benefit you’re entitled to – so what’s there to think about? Although Original Medicare can save retirees some money, it’s not a comprehensive health insurance solution. Medicare strategy can play an important role in your retirement future, especially as your health and medical costs change.

The team at Fullerton Financial Planning can help you understand the variables and answer the tough questions, like:

• How will my income influence my Medicare premiums?

• Should I enroll in Original Medicare as soon as I’m eligible or hold off as long as I still have my employer-provided coverage?

• Can private insurance help defray the out-of-pocket costs of Medicare?

We partner with Medicare strategy experts to ensure our clients get accurate answers to these important questions. We’re committed to ensuring your retirement won’t be derailed by unexpected out-of-pocket healthcare costs that could have been avoided with the right coverage.

Learn more about how we can help you plan by calling (623) 974-0300.