As a Medicare patient, you may have a difficult time finding Medicare doctors 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. Depending on where you live, you may have access to a number of providers or you may have access to only a few Medicare doctors. 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 take 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 Medicare doctors.
Do Your Research
Medicare patients can use the Physician Compare tool on www.Medicare.gov to find Medicare doctors in their area. To use the tool, you simply have to choose the type of physician you need (such as one specializing in cardiology, podiatry, oncology, or gynecology) 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 selecting that you want to see only participating providers who accept the Medicare-approved amount (listed in the Medicare fee schedule) as payment in full for all Medicare patient claims. This option can keep 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 the doctor for whom you are searching.
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, distance from your zip code or City, State, telephone number, 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, which refers to whether they accept the Medicare-approved amount as payment in full for Medicare patients’ claims), you will also see that information displayed on the initial list of Medicare doctors.
For additional information on a particular provider, you can click on the provider’s name. You will then be taken to the provider’s profile where you can find details on the physician. These may include his or her gender, information on his or her medical school and graduation date, languages spoken, and the address of each group practice location. You may also see information on the physician’s quality measurement in Medicare’s Physician Quality Reporting System, if he or she chose to participate.
If your search turns up empty, and you cannot find the kind of physician you need in your area, you may have to turn elsewhere for help.
Check Other Medicare Policies
Some Medicare policies offer their enrolled beneficiaries access to Medicare doctors that others do not. 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, you can make plans to switch your plan in the following calendar year. For assistance with a Medicare application, contact your local social security office.
Ask Around
You may be able to find a physician in your area who will agree to see a Medicare patient even if he or she is not a participating Medicare doctor. 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 policies, you will be unable 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.
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