Can I Use Any Doctor with a Medicare Supplement Plan?
This article was updated on: 04/24/2019
Some people worry about whether they’ll be able to use the doctor of their choice, or any doctor they want, when they start getting Medicare benefits. If you buy a Medicare Supplement plan to work alongside your Medicare coverage, you may generally have a wider range of doctors to choose from than if you were restricted to a provider network.
If you buy a Medicare Supplement plan (also known as a Medigap plan), you may be able to see the doctor of your choice. That’s because most Medicare Supplement plans let you visit any doctor or facility that accepts Medicare assignment (we’ll explain that below). The same is true not just for Medicare Supplement plans, but for Original Medicare (Part A and Part B).
Medicare Supplement plans: a quick overview
Standardized Medicare Supplement plans are offered by private insurance companies. They’re designed to work alongside Medicare Part A and Part B. Medicare Supplement plans can help pay Medicare’s out-of-pocket costs, such as deductibles, coinsurance, and copayments. Medicare Supplement plans are standardized with lettered names in 47 states (Massachusetts, Minnesota and Wisconsin have their own standardized plans). Different Medicare Supplement plans may cover different amounts of Medicare’s out-of-pocket expenses. Medicare and your Medicare Supplement plan will typically each pay its share of covered health-care costs. Because these plans supplement Medicare, most Medicare Supplements plans generally provide coverage and access to doctors and hospitals nationwide and without a referral—just as Medicare does.
Medicare Supplement plans: what you should know about Medicare assignment
As noted above, Medicare Supplement plans work alongside Medicare Part A and Part B. Usually Medicare, and Medicare Supplement plans require that your doctors and specialists accept Medicare assignment in order for your out-of-pocket costs to be covered. Accepting assignment means your doctor agrees to accept the Medicare-approved amount for services covered by Medicare and to file medical claims on your behalf. Your doctor agrees not to bill you more than what you owe as your cost-share (the coinsurance or copayment amount, and any deductible that may apply).
Whether or not you have a Medicare Supplement plan, certain rules apply about Medicare coverage of doctors who don’t accept assignment. If your doctor does not accept Medicare assignment but agrees to treat you, in many cases the doctor can charge you up to 15% more than the Medicare rate. You may have to pay your doctor at the time of service and send medical claims to your insurance company to be reimbursed for covered services.
Three Medicare Supplement plans—Plan F, Plan High-Deductible F, and Plan G—may cover 100% of these “excess charge” (that is, the charge of up to 15% more than the Medicare rate). If you enroll in a Medicare Supplement plan other than F, High Deductible F, or G, you may have to pay this charge.
With most types of Medicare Supplement plans, you can see the doctor of your choice. However, you may pay more if the doctor does not accept Medicare assignment. If you’re not sure whether your doctor accepts Medicare assignment, you may want to ask when you’re making an appointment.
Medicare Supplement plans: when might you have more limits on your choice of doctors?
In some states insurance companies offer Medicare SELECT, a type of Medicare Supplement plan that has a network of hospitals and, in some cases, doctors. If you enroll in a SELECT Medicare Supplement plan, you might have to use the hospitals and doctors within its network for non-emergency care in order to receive full insurance benefits. If you don’t use a Medicare SELECT hospital or doctor for non-emergency services, you might have to pay some or all of what Medicare doesn’t pay.
To learn more about Medicare Supplement plans and other Medicare coverage options available where you live, feel free to contact me.
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