Is Your Doctor in Your Medicare Plan’s Network? How to Tell

Your Medicare plan’s network can make a massive difference in your coverage and costs. If you’re enrolled in Original Medicare, and even if you have a Medigap plan to go with it, you likely won’t need to deal with networks too much, unless you have Part D coverage as well. As long as your doctor accepts Medicare assignment, Medicare Part A and/or Part B should help pay for your care in some way. And, with Medigap plans, you can get coverage if you see any Medicare provider in the United States. Networks should be factored cost equations, however, if you have privately-offered Medicare Advantage (Part C) or Part D plans.

For Part D, a network includes pharmacies where you may receive lower-priced prescriptions. Today, though, we’ll be discussing Medicare Part C (Medicare Advantage) networks and the doctors and health care providers that make them up. Let’s get started!

What’s the Difference Between In Network and Out of Network?

First and foremost, what does in network and out of network mean in regards to the health providers you visit? A physician being part of a network is similar to whether they accept assignment from Medicare. If they’re considered “in network,” it simply means that they have a contract with your Medicare plan (or your health insurance plan) to charge a certain pre-negotiated rate for services and items. Seeing in-network doctors can mean lower out-of-pocket costs for beneficiaries, depending on the plan or additional coverage, provided by the plan, over and above the minimum requirements of Medicare.

“In network” means a doctor has a contract with your plan to charge an agreed rate for services and items.

If a physician or health care provider is considered out of network, it means they don’t have this contract. While your plan may cover out-of-network services, it is usually at a greater out-of-pocket cost for you, the beneficiary. But, how do you know if your doctor is in your Medicare network before you receive the bill?

Is My Doctor in My Medicare Plan’s Network?

Finding out whether your doctor is in your plan’s network is fairly simple. You actually have a few different methods available, making it convenient and simple to make sure you’re working within your plan’s network.

Start with Your Doctor

If you already have a Medicare plan, one place to start finding out if your doctor is in your network is at your doctor’s office. Your doctor’s office should have your plan information and be able to tell you if they are in your network or not. They should also be able to list out what costs are associated with their services, as well as what plans they’re contracted with.

Your doctor’s office should have your plan information and be able to tell you if they are in your network or not.

If you’re choosing a Medicare plan, checking with your doctor what plans they’re considered in network for can also be helpful if you’d like to continue seeing them on your new plan.

Check with the Plan

To find out which doctors and health care practices are in network in your area, you can also contact your Medicare plan. Most plans should give you a provider directory for your plan that shows health care providers and facilities that make up the plan’s network. If you don’t have a directory, contact your plan to request one. Many plans are making this directory available online too.

Most plans should give you a provider directory that shows providers and facilities that make up the plan’s network.

When you enroll in a certain Medicare plans (like an HMO plan), you may be required to pick an in-network primary care physician. This can help ease the process, though, since you know you’ll be visiting an in-network provider. The downside to this, however, is if your current doctor isn’t in your plan’s network. In that case, you will likely want to change primary care physicians.

Working with an Agent

A final way to figure out if your doctor is in a plan’s network when choosing a Medicare plan is to work with a licensed Medicare sales agent. A good insurance agent can act as an invaluable guide through the Medicare enrollment process. Often, they’re able to get details on plans, including networks, before you enroll in a specific plan. They’ll also often help you find a plan that includes the doctors or health care providers you want. Best of all, working with an agent costs you nothing!

A good insurance agent can act as an invaluable guide through the Medicare enrollment process.

It may also be worth going down this route if your current plan’s network changes. If that happens and you want to stick with your current doctor, you may want to review your Medicare plan with an agent and switch plans, if you’re able to, to one that includes that doctor.

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Many people get attached to their doctor. This makes sense since we often keep the same doctor for years and grow to trust their medical opinions. At the same time, our health care needs to be affordable. Understanding plan networks and how to discover who’s in and who’s out of network can go a long way to ensuring that affordability and that you’re getting the most out of your Medicare coverage.