Aetna’s Medicare Advantage providers include primary care doctors, specialists, hospitals, surgical centers, laboratories, imaging centers, dentists, pharmacists, and other health-care professionals.
Full Answer
What kind of Doctor does Medicare cover?
Any doctor who accepts Medicare and is enrolled in the federal Medicare program should be able to provide you with covered health care services. How do I find a Medicare plan that accepts my primary care physician?
How do I choose a doctor who accepts Medicare?
By choosing a doctor who accepts Medicare, you’ll ensure you are charged the negotiated and acceptable rate. Your doctor’s office will also bill Medicare for your visit. In most cases, a doctor who accepts Medicare will also wait to hear back from Medicare before asking you to pay any cost difference if appropriate.
Does Medicare have a network of doctors?
If you have original Medicare, there are no networks, you’ll just need to ask if the doctor accepts Medicare. If you have Medicare Part C (Medicare Advantage), it’s more likely you’ll have to stay within your plan’s network of doctors.
Is Aetna Medicare PPO or HMO?
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage.
Does Mayo Clinic accept Medicare?
Yes, Mayo Clinic is a participating Medicare facility in Arizona, in Florida, in Rochester, Minn. and at all Mayo Clinic Health System locations.
Is Medicare accepted everywhere?
If you have Original Medicare, you have coverage anywhere in the U.S. and its territories. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Most doctors and hospitals take Original Medicare.
Why do doctors not like Medicare?
Can Doctors Refuse Medicare? The short answer is "yes." Thanks to the federal program's low reimbursement rates, stringent rules, and grueling paperwork process, many doctors are refusing to accept Medicare's payment for services. Medicare typically pays doctors only 80% of what private health insurance pays.
Why do doctors not like Medicare Advantage plans?
If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
How to contact a primary care physician who accepts Medicare?
Find out more about the Medicare Advantage coverage options in your area by calling a licensed insurance agent at. 1-800-557-6059. 1-800-557-6059 TTY Users: 711 24 hours a day, 7 days a week, ...
What can a licensed agent do for Medicare Advantage?
A licensed agent can help you review Medicare Advantage plans available in your area and may be able to provide you with information about primary care physicians located near you who participate in each given plan.
What is Medicare assignment?
This means the doctor accepts Medicare patients and agrees to accept the Medicare-approved amount as full payment for their goods or services. Does not accept assignment.
What is the role of a primary care physician?
One part of the role of a primary care physician is to coordinate a patient’s care between various specialists, labs and other health care facilities. This type of coordinated care can help improve communication and foster a more “team” approach to your care. Convenience.
What does "D.O." mean in medical terms?
A doctor with “D.O.” (Doctor of Osteopathic Medicine) after their name – instead of the traditional “M.D.” (Doctor of Medicine) – may combine some traditional medical training with additional and alternative medicine practices. This will depend on the particular doctor.
What is an internist doctor?
This will depend on the particular doctor. An internal medicine doctor, or internist, specializes in the prevention, diagnosis and treatment of diseases in adults. Ask your friends and family. It never hurts to ask your close friends and family about their doctor.
Does Medicare Advantage require a primary care doctor?
Not every type of Medicare Advantage plan requires a primary care doctor. A Medicare HMO (Health Maintenance Organization) plan generally requires the use of a primary care doctor, and you must obtain referrals before seeing a specialist.
How to find a doctor who accepts Medicare?
There are a few simple ways to find a doctor who accepts your Medicare plan: 1 Visit physician compare. The Centers for Medicare & Medicaid Services (CMS) has a tool that allows you to look up doctors near you and compare them side-by-side. 2 Check the Medicare website. The official Medicare website has many resources for finding providers and facilities that accept Medicare near you. For example, you can find and compare hospitals or other providers and search what services are covered by your Medicare plan. 3 Check your insurance company provider listings. Medigap and Medicare Advantage are Medicare plans provided through private insurance companies. To find doctors that accept these forms of coverage, you’ll need to check with your selected provider for a listing. 4 Check your network. If your Medicare coverage is provided through an insurance provider with a network of doctors and hospitals, check with the company to be sure your doctor is in their network This can be done by calling your insurance provider or checking their website. 5 Ask trusted friends and family members. If you have any friends or family members who also use Medicare, ask them about their healthcare providers. How attentive is the doctor? Does the office handle their requests promptly and with ease? Do they have convenient hours?
Why is it important to verify that your doctor accepts Medicare?
The takeaway. For most people, having a doctor they trust who is located conveniently is an important part of their healthcare. While it is an extra step, it’s important to verify that your doctor accepts Medicare coverage or is in your Part C network to ensure you get the most from your Medicare benefits.
What is Medicare Advantage?
Medigap and Medicare Advantage are Medicare plans provided through private insurance companies. To find doctors that accept these forms of coverage, you’ll need to check with your selected provider for a listing. Check your network. If your Medicare coverage is provided through an insurance provider with a network of doctors and hospitals, ...
What is the most important factor to consider when choosing a Medicare plan?
When choosing a Medicare plan, one important factor to consider is finding doctors who accepts Medicare near you. No matter if you are looking for a clinic, hospital, new doctor, or if you just want to keep the doctor you’ve been seeing, finding out who takes Medicare is important. It all comes down to doing a little research before you schedule ...
What is an HMO plan?
If you buy a type of Medicare Advantage plan called a Health Maintenance Organization (HMO), you’ll be given a list of in-network providers to choose from. If you decide to select a provider who is out of network, you may owe a higher cost or the full out-of-pocket amount for those services.
Is Healthline Media a licensed insurance company?
Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance. Last medically reviewed on February 21, 2020.
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Find Out If Your Doctor Accepts Medicare Advantage
One of the most important parts of your healthcare is choosing your doctor. Everyone wants to see a doctor that understands their needs and doesn’t cost an arm and a leg. But not all doctors accept Medicare. So, how do you navigate finding a primary care physician that accepts Medicare near you?
Why is it Important to Find a Doctor Who Accepts My Medicare Plan?
Simply put, visiting doctors who don’t accept your Medicare Advantage plan or participate in your plan’s network will likely cost you more money. Depending on the type of plan you are enrolled in, you may have to visit certain doctors within a network of providers or risk paying for your services out-of-pocket.
What Is A Provider Networks?
A provider network consists of doctors, specialists, and hospitals. These provider networks contract with plans to provide care to the plan’s members. The benefit of a provider network is, typically, lower costs for you. There are two different provider networks that you should be familiar with:
Finding a Doctor
It will benefit you in the long run to check if your preferred doctors and specialists work with Original Medicare or your Medicare Advantage plan. You can save money long-term by having access to a doctor you trust.
What is Medicare Advantage?
Medicare Advantage plans cover all the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance). Plus, most plans include prescription drug coverage and additional benefits not covered by Original Medicare. Medicare Advantage plans are provided by Medicare-approved private insurance companies.
Does UnitedHealthcare have a contract with Medicare?
Enrollment in the plan depends on the plan’s contract renewal with Medicare. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program.
Providers non in the network not required to treat you
Here is an excerpt from one company that touts your ability to go to any provider you want with their PPO Advantage plan:
What about emergency coverage?
Yes, emergency situations are covered as in network. And providers are required to treat you.
Find a doctor
Find doctors or pharmacies within your network and search for other providers like dentists or specialists.
Shopping for a new plan?
If you're looking for a new plan, check to see if your provider or pharmacy is covered.
