Should I change to a doctor in the network?

My doctor is not in the network for my new Medicare plan. Help me decide about making a change.

Keeping your doctor or switching to a new one is a personal choice. I’ve been seeing the same doctor for several years and have a high level of loyalty and trust in the care I receive. Yet I would consider a change for different reasons. Like managing the cost of my health care. That’s why it’s important to know if my doctors are in my health plan’s network.

Where you get your care will impact how much you pay

Many Medicare plans have a network of doctors, clinics, hospitals and pharmacies that you can use for your health care. You typically pay the least amount when you use a doctor or pharmacy in the network. If you get care out of the network, you usually pay more for those services. Some plans may not provide coverage at all for out-of-network services. You can learn more about this in the article, Why I should know my network.

If you changed your Medicare plan for this year, you may have a different network than your previous plan. It’s important to check your new plan’s network so you can get the care you need from the provider of your choice and understand your costs.

Things to consider before changing doctors

There are many things to think about before you change doctors. Ask yourself these questions to decide if it’s important to keep the same doctor or if you’re willing to make a switch.

  • Do you have ongoing or specialized care needs?
    It might be important to you to keep your doctor. Or, your clinic can make sure a new doctor has your medical records to continue your care.
  • Will you need surgery or a procedure that you’ve had before?
    For example, maybe you had a right knee replacement and are planning to have a left knee replacement. You may prefer to have the same doctor for the second surgery. Or your surgeon can provide your medical records to another doctor if you are willing to switch.
  • Do you only visit a doctor once in a while?
    You may be OK with choosing a new doctor that is in a plan’s network.
  • Is paying less for health care important to you?
    When you use a doctor in the network, you pay less for covered services. That means you have a lower copayment (flat dollar amount) or coinsurance (percentage of the total bill you pay). When you get medical care from an in-network doctor, you also have a lower annual maximum amount that you pay out of pocket.

We’ll help you understand your benefits and choices

If you need help understanding your Medicare plan’s network, call your health plan’s member services at the phone number on the back of your ID card. Ask them to explain your in-network and out-of-network benefits and your provider choices. You can use that information to understand how your Medicare plan works.