I Need to Change Doctors, What Do I Do?
This article was updated on: 11/17/2015
Depending on what type of coverage you have, changing doctors under Medicare will require different steps:
- If you have Original Medicare, Part A and Part B: With this coverage, you can go to any doctor who accepts Medicare patients. You can use the Physician Compare tool at Medicare.gov to help you find a doctor who accepts Medicare assignment. It’s a good idea to call the doctor’s office and verify that he or she will accept new Medicare patients before you make an appointment.
- If you are covered by both Original Medicare and Medicaid: In this situation, you should verify with the state you live in that the doctor you want to see accepts both Medicare and Medicaid patients. Contact your state Medicaid office directly, as well as contacting Medicare and the new doctor.
- If you have a Medicare Advantage HMO plan: This type of plan requires you to see doctors within the plan’s network if you want full coverage, and you usually have to select a primary care physician who can then refer you to specialists, as needed. HMO plans have a list of all doctors who are in the plan’s network–this list can be found on the plan’s website, or you may request a printed copy. Check this list to see if the doctor you want is in the plan’s network. To change your primary care doctor, you will need to contact your insurance company directly, either by phone or sometimes through the plan’s website. There will be a member phone number on the back of your plan ID card where you can call for assistance. After you’ve selected a new primary care physician, the plan should send you a new ID card listing the doctor on it.
- If you have a Medicare Advantage PPO plan: This type of plan often has a list of preferred doctors, and if you choose one of these, your cost-sharing may be lower. You can find this list on the plan’s website, or you may request a printed list. To change your doctor, you don’t typically need to contact the insurance company, but keep in mind the cost differences. When you call the doctor you want to make sure he or she accepts new patients.
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