The Doctor is In (Maybe)

The doctor’s in, but is your doctor really IN?

Even if the sign says, “The doctor’s in,” you need to double check, because even if the doctor’s in, he or she may not be in your Medicare’s plan network. And depending on the type of plan you have, you may not have coverage outside of the network. That is the case with most HMO plans. Click here to learn more about these types of plans.

First, find out if your doctor “participates” in Medicare and takes assignment. Then, ask if the doctor has specifically “opted out” of Medicare. If she has opted out, you may want to find another doctor unless you can pay cash for the services.

Then – as with any insurance plan – you need to know your numbers. If you’re about to enroll in Medicare Advantage or Medigap, ask your agent to clearly spell out for you all your out-of-pocket costs — deductibles, co-pays, coinsurance and your coverage limits.

What if you have a Medicare supplement plan, like Plan F or Plan N?

Some Medicare Supplement plans (or Medigap plans as Medicare calls them) can be a problem too if you doctor does not accept Medicare assignment.

The term “Medicare assignment” may mean little to you until you find out that a new doctor you are seeing does not accept what Medicare pays for a given service. A “non-participating” doctor who does not accept the assigned cost can charge up to 115 percent of the Medicare approved amount.  This means that Medicare & your supplement plan will still pay for the services this doctor provides even if he does not accept assignment, but you may have to pay some of the costs plus the 15% extra charges.

Wondering if any of this applies to you?

There is a simple way to find out. Work with an agent who can tell who’s in and who’s out and whether or not your plan will pay when you encounter these 15% excess charges.


If you would like help comparing your needs against the many Medicare plans out there or if you just want to ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  

The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

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