Can I Keep My Doctor When Changing Medicare Plans?

With Original Medicare plus a Medigap policy, there is no network. You can see any doctor or hospital in the country that accepts Medicare, and you do not need referrals. Because Medigap plans with the same letter are federally standardized, switching from one company's Plan G to another company's Plan G changes your premium, not your doctor access.

Medicare Advantage works differently. These plans build networks of doctors and hospitals, usually within your local area. HMO style plans generally cover only in-network care except in emergencies, while PPO style plans let you go out of network at a higher cost. When you change Medicare Advantage plans, your doctor comes with you only if he or she participates in the new plan's network.

Even people who keep the same Medicare Advantage plan can lose a doctor, because networks are renegotiated every year and doctors can leave mid-year too. Your Annual Notice of Change, which arrives by September 30, describes what your plan will look like the following January, so read it rather than assuming everything stays the same.

Do not rely on the plan's online directory alone, since directories can lag behind reality. The most reliable check is to call your doctor's office, give them the exact plan name for the coming year, and ask whether they will accept it. If you split the year between two states, remember that Medicare Advantage networks are usually local, while Medigap travels with you anywhere in the country.

Write down every doctor you see, plus your hospital preference and your prescriptions, and verify each one against any plan you are considering during the Annual Enrollment Period, October 15 to December 7. That hour of checking prevents most unpleasant January surprises.

If you do switch to a Medicare Advantage plan and then discover a doctor is out of network, the Medicare Advantage Open Enrollment Period from January 1 to March 31 lets you make one change, either to a different Medicare Advantage plan or back to Original Medicare. A licensed independent advisor can run the doctor and drug checks for you at no cost before you commit.