In short, Medicare is not accepted by all healthcare providers. There are different parts of Medicare. Some are accepted more widely by providers while others are not. Some places are more likely to accept Original Medicare over Medicare Advantage, and vice versa. Others are more likely to accept certain types of Medicare Advantage plans, but not others. For a better understanding of whether Medicare is accepted by healthcare providers, read on below.
Original Medicare
Many doctor’s offices and hospitals accept Medicare. In order to accept Medicare, they have to be Medicare-certified and meet certain Medicare quality criteria. Most hospital systems accept Medicare. Many private doctors also accept Original Medicare, but this varies more.
Medicare Advantage
Medicare Advantage is slightly different from Original Medicare. You have to purchase Parts A and B of Original Medicare in order to apply for a Medicare Advantage Plan. Once you purchase Parts A and B, you can start shopping for a Medicare Advantage Plan you like from a private insurer. After you find one you like, you enroll. The major advantage of Medicare Advantage plans is the extra bonuses they are accompanied by. For example, Original Medicare does not cover vision or dental insurance. However, many Medicare Advantage Plans do.
There are 6 types of Medicare Advantage Plans:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plans (SNPs)
- HMO Point-of-Service (HMO-POS)
- Medical Savings Account (MSA)
Let’s focus on the two most common: HMOs and PPOs. A PPO is a type of plan in which the insurance companies make a deal with different providers and hospitals. Certain providers and hospitals become in-network, and certain providers and hospitals become out of network. People pay more for a PPO monthly because while it incentivizes them to see a doctor in-network, they can still see someone outside of their network and the insurance company will still pay a certain portion. In contrast, an HMO is a type of plan in which you pay less monthly, but you are only allowed to see your in-network providers. Otherwise, the plan will not pay.
Now that we understand the difference, we can compare the two plans. HMOs are less likely to be accepted by your provider while PPOs are more likely to be accepted. PPO plans emphasize flexibility and cost a bit more while HMO plans sacrifice flexibility for better affordability. A PPO plan means you can go to many different doctors even if they are out of your network, but the doctors in your network will cost you less money out-of-pocket. An HMO is cheaper because it restricts you from seeing out-of-network doctors. Finding a provider in your PPO network is easier than finding one within the HMO network.
Fortunately, there are many different ways to go about finding a provider in your network. For help finding a provider and other Medicare tips and tricks, call us at Wise Insurance today!
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
