| Mon, Aug 01, 2011 @ 09:00 AM

Your Medicare Plan, Your Doctor and You

Posted by Medicare Made Clear

Your Medicare Plan, Your Doctor and YouWhat’s most important to you when it comes to choosing a Medicare plan? If your answer is “I want to keep seeing my current doctor,” then you need to know which plans will allow you to do so. Even if you don’t have a specific doctor you like to see, it’s important to know which doctors the plans you may be considering will cover.

Medicare, Two Ways

You can get your Medicare coverage in two ways. You can choose Original Medicare, which is administered by the federal government. Or, you can get a Medicare Advantage plan (Part C) from a private insurance company approved by Medicare.

  • With Original Medicare (Parts A and B), you can see any doctor who participates in the Medicare program and receive care at any hospital nationwide. And no matter where you live, you get the same coverage for the same cost.
  • With a Medicare Advantage plan, you may or may not be able to choose your own doctor or hospital, depending on the type of plan. However, these plans cover the same services as Original Medicare and usually include additional coverage such as prescription drugs, dental, vision and hearing care and wellness programs—all in one plan. Plans are offered regionally and the total benefit package and cost can vary from plan to plan.

Medicare Advantage Plans, Many Ways

Congress created Medicare Advantage plans to offer beneficiaries more choices. Private insurance companies create different kinds of plans to meet the varying needs of people in their service areas.

Medicare Advantage coordinated care plans include:

  • Health Maintenance Organization Plans (HMO)
  • Point of Service Plans (POS)
  • Preferred Provider Organization Plans (PPO)
  • Special Needs Plans (SNP)

In these types of plans, a primary care doctor may oversee, or “coordinate,” your care. This is important for two reasons:

  1. Medicare Advantage coordinated care plans provide services through a network of contracted providers. If you have a doctor that you want to continue to see, then you need to make sure he or she is “in-network” for any plans you may be considering. Some plans allow you to see doctor’s that are “out-of-network” but it may cost more.
  2. In Medicare Advantage coordinated care plans, you usually need a referral from your primary care doctor in order to see a specialist. Some plans also require preauthorization of certain specialist services before you can receive them.


Two other Medicare Advantage plan types offer more flexibility in provider choice. These include:

  • Private Fee-For-Service Plans (PFFS)
  • Medical Savings Account Plans (MSA)

Generally, these plans require members to take on more responsibility for the financial management of their health care. With a PFFS, the plan pays providers according to its terms, conditions and payment rates. If the provider won’t accept this, then the member may be responsible for the difference. With an MSA, members have a savings account that they manage themselves and use to pay for health care services.

This table summarizes provider choice for Original Medicare and the different Medicare Advantage plan types.

This table summarizes provider choice for Original Medicare and the different Medicare Advantage plan types.

Know Your Preferences, Research Your Choices

The ability to choose your own doctor is just one of many features to consider as you research your Medicare plan choices. Others include what services are covered, how much your out-of-pocket costs will be and what quality of service you can expect from the plan and its provider network. It’s important to identify and prioritize which of these is most important to you.

For more information contact the Medicare helpline 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. You can also contact UnitedHealthcare® Medicare Made Clear to learn more 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, 7 days a week.


Steps for deciding between Original Medicare and a Medicare Advantage plan

The basics about Medicare Advantage plans

An overview of Medicare Advantage plans (Part C)

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