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As a Medicare patient, you may have a difficult time finding doctors who accept Medicare in your area. Different counties across the nation are covered by different Medicare policies and have a varying number of contracted Medicare doctors who provide services to Medicare patients. Different Medicare policies may also have different Medicare doctors listed as in-network providers.
If you do not know how to find Medicare doctors who accept your particular plan, you may find your medical expenses are higher than you anticipated. To make sure your medical expenses are covered by your Medicare policies, you need to find out which providers in your area are enrolled with Medicare.
Always ask if your doctor is enrolled with Medicare
When looking for a new doctor, or making an appointment with a doctor you have not seen for a while, always ask if he or she is enrolled with Medicare. If the answer is no, it means your doctor has opted out of the Medicare program. Doctors who have opted out of Medicare can charge whatever they want, but they cannot bill Medicare for reimbursement — that means you cannot file a claim with Medicare, so you will be responsible for paying the full cost of your care.
You should also ask if the doctor is a participating or nonparticipating Medicare provider. Nonparticipating providers receive a lower reimbursement from Medicare, which means you will have to pick up more of the bill.
Use online research tools to find Medicare providers
Medicare beneficiaries can use the Physician Compare tool on www.Medicare.gov to find Medicare doctors in their area. To get to the tool, simply click "Facilities & Doctors" and then "Find a doctor." You can choose the type of physician you need (such as one specializing in cardiology, podiatry, or oncology) and enter your zip code or city and state. You can also refine your search by selecting a particular gender for your doctor or by asking to show only participating providers who accept the Medicare-approved amount as payment in full for all Medicare patient claims. (This option can prevent you from receiving unexpected medical bills.) If you are searching for a particular doctor, the Physician Compare tool also allows you to enter the last name of your doctor.
Once you click "Search Providers" you will see a list of all the Medicare providers in your area who meet the selection criteria you entered. You can further refine or expand your search criteria by selecting sub-specialties or changing the number of miles you are willing to travel from your zip code. The list of Medicare doctors will include the physician's name, address, telephone number, distance from your zip code or city, group practice locations, and type of services provided. You may also see a link to "Map and Directions." If the provider has any additional information (such as gender or Medicare assignment), you will also see that information displayed on the initial list of Medicare doctors.
Consider other options if necessary
If you cannot find a Medicare provider that meets your needs, you may be able to find a doctor in your area who will agree to see a Medicare patient. Some doctors will agree to sign a private contract that specifies what your medical expenses will be for each type of service. You may even be able to negotiate a price you can afford. However, you should know that if you sign a private contract with a physician who does not accept Medicare, you will not be able to file a claim with Medicare for help covering any related medical expenses. This means you will be responsible for paying the full cost of your care.
You can also ask your state medical society or area hospitals for referrals. They often keep a directory of doctors in the area, and they may have information on which providers are listed as Medicare doctors. If you have difficulty locating a general practice physician or a family doctor who accepts Medicare policies, you can always seek care from an urgent care clinic in your area. While the clinic's providers may be reluctant to provide continuing care, they can assist with illnesses and write prescriptions. Additionally, almost all urgent care clinics accept Medicare. You may even be able to find a provider there who will agree to see you on a regular basis.
Check other Medicare policies
Some Medicare policies offer beneficiaries access to Medicare doctors that other policies do not offer. Perhaps a specific Medicare Advantage Plan in your area has a contract with the Medicare doctors you need. Do not be shy about calling the various plans and asking for information on their providers. If you find that other Medicare policies offer choices your current plan does not offer, you can make plans to switch your plan during the next Annual Open Enrollment Period for Medicare.