How do I check if my doctor accepts Medicare?

The most reliable way is to call your doctor's office directly and ask if they are accepting new Original Medicare patients or if they are in-network for your specific Medicare Advantage plan. You can also use the Physician Compare tool on the official Medicare.gov website to find and compare providers who accept Medicare.

What's the difference between an HMO and a PPO plan for keeping my doctor?

An HMO (Health Maintenance Organization) plan generally requires you to use doctors, specialists, and hospitals within its network. You'll also typically need a referral from your primary care physician (PCP) to see a specialist. A PPO (Preferred Provider Organization) plan offers more flexibility, allowing you to see both in-network and out-of-network providers, usually without a referral. However, your out-of-pocket costs will be lower if you stay in-network.

What happens if my doctor leaves my Medicare Advantage plan's network?

If your doctor leaves your plan's network, you will be notified by your insurance company. You may be able to continue seeing them, but your costs will be higher (out-of-network rates). This situation may also qualify you for a Special Enrollment Period (SEP), allowing you to switch to a different Medicare Advantage plan or return to Original Medicare to ensure you can continue seeing your preferred provider affordably.

Do I need a referral to see a specialist with Medicare?

With Original Medicare, you generally do not need a referral to see a specialist who accepts Medicare. With Medicare Advantage plans, it depends on the plan type. HMO plans almost always require a referral from your PCP to see a specialist, while PPO plans typically do not.

Can a Medicare Supplement (Medigap) plan help me keep my doctor?

Yes, absolutely. Medigap plans supplement your Original Medicare coverage. Since they are not network-based, you can see any doctor or specialist in the U.S. who accepts Original Medicare. This provides the greatest freedom and flexibility in choosing your healthcare providers.

Can I Keep My Doctor with Medicare in Florida?

Name: Integrity Health Solutions
Address: St. Petersburg, FL, 33701, US
Telephone: +1-727-348-0589
Price range: Free

One of the most common and important questions we hear at Integrity Health Solutions is, "Will I be able to keep my doctor if I switch to Medicare?" For most people, the relationship with their primary care physician and specialists is built on years of trust and familiarity. The thought of having to change doctors can be a significant source of anxiety when navigating the transition to Medicare. The answer, however, isn't a simple yes or no; it depends entirely on the type of Medicare coverage you choose.

This guide will walk you through how provider access works with Original Medicare, Medicare Advantage plans (like HMOs and PPOs), and Medicare Supplement (Medigap) policies. Understanding these differences is crucial for making an informed decision that ensures you maintain access to the healthcare providers you know and trust. Our goal is to empower you with the knowledge to choose a plan that fits your health needs and your preference for specific doctors and hospitals right here in Florida.

Provider Choice with Original Medicare (Part A & Part B)

Original Medicare, administered by the federal government, consists of Part A (Hospital Insurance) and Part B (Medical Insurance). It offers the most extensive freedom of choice when it comes to healthcare providers. If you enroll in Original Medicare, you can visit any doctor, specialist, or hospital in the United States that accepts Medicare assignment.

A provider who "accepts assignment" agrees to accept the Medicare-approved amount as full payment for covered services. The vast majority of doctors in the U.S. (over 95%) accept Medicare, so your chances of keeping your current doctor are very high. You generally don't need a referral to see a specialist, giving you direct access to the care you need. This flexibility is a primary reason why many people prefer to stay with Original Medicare, especially if they travel frequently or have a team of trusted specialists.

However, it's important to always confirm. Before your first appointment on Medicare, simply call your doctor's office and ask, "Do you accept Medicare assignment?" This quick confirmation can provide peace of mind. While Original Medicare offers great flexibility, it does have gaps in coverage, leading to out-of-pocket costs like deductibles and coinsurance. This is where Medigap and Medicare Advantage plans come in.

The Role of Medicare Supplement (Medigap) Plans

A Medicare Supplement plan, also known as Medigap, works alongside Original Medicare. It helps pay for some of the out-of-pocket costs that Medicare doesn't cover, such as your Part A and Part B deductibles, coinsurance, and copayments. Crucially, Medigap plans do not have provider networks. If your doctor accepts Original Medicare, they will accept your Medigap plan, regardless of which insurance company sold you the policy. This means a Medigap plan preserves the freedom of choice you get with Original Medicare, allowing you to see any Medicare-accepting provider in the country.

Understanding Medicare Advantage (Part C) Provider Networks

Medicare Advantage plans are an alternative way to receive your Medicare benefits. Offered by private insurance companies approved by Medicare, these plans bundle your Part A, Part B, and often Part D (prescription drug) coverage into a single plan. While they often feature attractive benefits like low or $0 monthly premiums and extra perks like dental and vision, they almost always come with a defined provider network.

This is the most critical factor when considering if you can keep your doctor. You must use doctors and hospitals that are in your plan's network to receive the lowest out-of-pocket costs. Let's look at the most common types of networks.

HMO vs. PPO: The Network Trade-Off

The two most common types of Medicare Advantage plans in Florida are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. Their network rules are very different.

Feature	HMO Plans	PPO Plans
Provider Network	Must use in-network providers, except for emergencies.	Can see both in-network and out-of-network providers.
Primary Care Physician (PCP)	Usually required to select a PCP to coordinate care.	PCP selection is often optional.
Specialist Referrals	Referrals from your PCP are almost always required to see a specialist.	Referrals are generally not needed to see specialists.
Out-of-Network Costs	Care is typically not covered at all, except for emergencies.	Covered, but at a higher cost-sharing (copay, coinsurance) than in-network care.

How to Check if Your Doctor is in a Plan's Network

Before enrolling in any Medicare Advantage plan, it is absolutely essential to verify that your preferred doctors, specialists, and hospitals are in the network. Do not rely on assumptions.

Use the Plan's Online Provider Directory: Every insurance company has an online tool to search for in-network providers. Be sure to search the specific plan name, as networks can vary even within the same company.
Call the Doctor's Office: This is the most direct and reliable method. Call your doctor's billing department and ask, "Are you in-network for the [Plan Name] from [Insurance Company]?"
Work with an Independent Agent: An independent agent, like our team at Integrity Health Solutions, has the tools and expertise to check multiple plans at once. We can quickly verify which plans your doctors accept, saving you time and preventing costly mistakes. Our service is free, and our advice is unbiased. Call us at (727) 348-0589 to get started.

What If My Doctor Isn't in the Network?

If you find that your doctor is not in the network of a Medicare Advantage plan you're considering, you have a few options. You could choose a PPO plan, which would allow you to continue seeing your doctor, but you'll pay higher out-of-network costs. Alternatively, you could find a new primary care physician within the plan's network. For many, however, the best option is to choose a different type of coverage altogether, such as Original Medicare with a Medigap plan, which ensures you can keep your doctor without network restrictions.

Residents in Florida cities like St. Petersburg, Tampa, or Sarasota have access to a wide variety of plans, but networks can be very localized. A plan that covers your doctor in one city may not in another, making it vital to check networks carefully. As a local agency based in St. Petersburg, we have deep knowledge of the provider networks across Pinellas, Hillsborough, and surrounding counties.

Your Partner in Medicare

Choosing the right Medicare plan is a significant decision, and ensuring you can keep your trusted doctors is a top priority. At Integrity Health Solutions, we're here to help you navigate this complex landscape. As a licensed and independent agency (FL License G288975), our loyalty is to you, not a specific insurance company. We'll help you compare all your options, verify provider networks, and find the plan that best suits your healthcare needs and preferences.

Don't leave your healthcare to chance. Contact us today for a personalized, no-cost consultation and gain the confidence that comes from making an informed Medicare choice.