In short, you do not have to choose a healthcare provider with Medicare. Original Medicare, that is. In certain Medicare Advantage plans, you are required to choose a primary care doctor. Read on to learn more about the structure of Original Medicare and when you have to choose a primary care physician (PCP).
Structure of Medicare
Medicare is a highly flexible health insurance program. It has 4 parts: Parts A, B, C, and D. Parts A and B are often referred to as Original Medicare. Part D is an optional addition where you purchase a plan from a private insurer to cover prescription drug costs. Part C, Medicare Advantage, is like an alternative to Original Medicare. You still purchase Parts A and B, but Part C has many bonuses, like prescription drugs, transportation, vision, gym memberships, etc. Each Part C plan is highly different.
Freedom with Original Medicare
Original Medicare is designed to help consumers increase their options of where and how to receive quality care. In Original Medicare, you can go to any doctor or hospital that accepts Medicare. Most places and providers accept Medicare, so you have many options nationally. You also do not need to select a primary care provider or request referrals in order to see a specialist.
Choosing a PCP with Medicare Advantage Plans
Medicare Advantage Plans are different. They are considerably less flexible. They often have networks of people you can see and providers who are out-of-network and therefore not included in your coverage. There are multiple types of Medicare Advantage plans. One plan type, called a Health Maintenance Organization (HMO), is the least flexible. In an HMO, you are required to choose a PCP. That PCP also has to be in-network. The networks can be relatively small depending on your area. You must also request a referral from your PCP in order to see a specialist.
Another type of Medicare Advantage Plan, called a Special Needs Plan, may also require choosing a PCP. The exact requirements depend on the exact plan.
The downside of choosing a plan that requires you to choose a PCP is it restricts your flexibility. You are restricted to certain networks and must find someone you like as your main physician in that network. Referrals must go through that PCP as well. The upside of choosing a plan that requires you to choose a PCP is that they are often more cost-effective in the short term.
If you have questions about whether you need to choose a PCP or how to go about doing so, contact us at Bobby Brock Insurance today.