Sunday, July 14, 2024

How To Change Primary Doctor On Medicare

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What If I Missed The Open Enrollment Period

How to Switch Your Primary Care Doctor with a Medicare Advantage Plan

If you missed open enrollment in the fall, you still may be able to enroll in a different plan during the Medicare Advantage Open Enrollment Period , which runs annually from January 1 March 31. During MAOEP, beneficiaries who already have a Medicare Advantage plan can switch insurance providers and enroll in another MA plan.

During MAOEP, you can also disenroll from your current plan and revert to Original Medicare, with the option to enroll in a Part D prescription drug plan.

If you dont have a Medicare Advantage plan and still have questions about how to change Medicare plans, talk to your insurance agent about choosing a Medicare plan thats best for you.

What Happens If Your Pcp Retires

If your PCP retires or leaves the plan, we send a letter to let you know. The letter includes a PCP change form and a return envelope so you can select a new PCP. This letter is generally sent at least 30 days before your PCP leaves the plan, however sometimes certain circumstances prevent us from alerting you 30 days in advance, such as if your PCP passes away unexpectedly.

Medicare Annual Enrollment Period

Open enrollment takes place from October 15 December 7 each year. During this time, you can:

  • Sign up for a new Medicare plan
  • Switch from Medicare to Medicare Advantage
  • Add a Medicare Part D plan to your current Medicare coverage
  • Add a Medicare supplement plan to your current Medicare coverage

All changes go into effect on January 1 of the upcoming year. Be sure to review your plan each year, as plans change annually and the plan that worked for you one year may not be your best option in the following year.

If you do not choose a new plan during open enrollment, your existing coverage will continue into the following year. If you did not have previous coverage, you could be subject to a surcharge and pre-existing conditions may not be covered by your provider in the future, so its important to start planning before you turn 65.

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How To Change Doctors

This article was co-authored by Chris M. Matsko, MD. Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017. This article has been viewed 125,333 times.

On occasion, it’s necessary to change doctors. This is often due to circumstances, such as moving away, but can sometimes be the result of patient dissatisfaction. Whatever the reason for the switch, the process of finding a new doctor requires time, research, and care.

Get To Know The Doctor

How to Switch Your Primary Care Doctor with a Medicare ...

At the first visit, its important to make sure your doctors philosophy of care lines up with your own. Consider asking questions such as:

  • Why did the doctor decide to go into primary care?
  • What is his or her favorite thing about being a doctor?
  • What does he or she wish more patients would do after they leave his or her office?

If your doctors outlook on patient care meshes nicely with your preferences, you may be more likely to follow his or her recommendations in between appointments. So take this into consideration when deciding whether to stick with a doctor following your first appointment.

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If You’re Already A Bcn Advantage Member

If you didn’t select a primary care physician when you first bought your plan, or want to change your current one, it’s easy to do online.

  • Once you’ve logged in, click Doctors & Hospitals in the blue bar at the top of the page.
  • Find the row associated with your name and click Change. You’ll be taken to our Find a Doctor tool. Follow the instructions to find a primary care physician in your plan.
  • Don’t have an account with us yet? It only takes a few minutes to register.

    You can also change your primary care physician over the phone. Just call the number on the back of your Blues ID card and we’ll help.

    What Is A Primary Care Physician

    A primary care doctor , is a doctor that practices general medicine. PCPs help with your health including preventative care, routine physicals and screenings, annual shots, diagnosing and managing chronic conditions, and general minor illnesses or injuries.

    There are five different kinds of primary care doctors, each with a different background and area of focus.

    • Family medicine doctor: Doctors that can provide health care for your whole family and act as one-stop-resource for treating a variety of needs and services for babies, children and adults.
    • Internal medicine doctor: Doctors that care for adults only and focus on treating issues that primarily affect adults such as high blood pressure.
    • Internal medicine-pediatrics doctor: Dual certified in both internal medicine and pediatrics, these physicians can care for both kids and adults and help with balancing regular preventative care needs with specialized care needs.
    • Pediatrician: Physicians that specialize in child health care from birth through early adulthood and are experts in developmental milestones, routine care, and treating minor illnesses and injuries.
    • OB-GYN : Experts in womens health that help with family planning, pregnancy, menopause, and preventative screenings like mammograms and Pap smears.

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    Tips For Choosing A Primary Care Doctor

    Who knows you best? Your spouse? Son or daughter? Best friend? If your primary care doctor doesnt make the list, you could be missing out on one of the most important relationships when it comes to your health and well-being.

    Your primary care doctor may be more than just a doctor. Over time, he or she may learn the nuances of your medical history, your response to medications, your personality, your lifestyle and your treatment preferences.

    That intimate knowledge can make a big difference to your health. Studies show that when peoples access to primary care doctors improves, their risk of dying of cancer, heart disease and strokes declines.1

    How To Search For An In

    Medicare Rules When You Need to Change Doctors What Do You Do?
    • Log in to the myCigna® website to search for an in-network provider. The provider directory on shows you results based on your health plan network and your location.
    • Know before you go. Before you visit any provider or facility, we recommend you to be sure they are in your plans network, as well as confirm their address, office hours, and that they are accepting new patients.
    • Meet the provider in person. Ask to schedule an introductory appointment. This appointment can help you decide if the provider is a good fit for you.

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    What Does A Primary Care Doctor Do

    A primary care physician is the medical professional who generally oversees your health care, wellness visits, and preventive care. If you get sick, you generally see your primary care physician first. If you need specialist care, your primary care doctor may refer you to the specialist.

    According to the U.S. National Library of Medicine, a primary care provider could be:

    • A generalist doctor who specializes in internal medicine or family practice
    • Nurse practitioners with training in adult care or geriatrics
    • Other practitioners

    Unitedhealthcare Senior Care Options Plan

    UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

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    How Do You Get A Pcp

    The ways to choose a PCP are:

    • Go to the doctors office,
    • Go to the DHS office in your county, or
    • List your choices for a PCP on the Medicaid or ARKids First application.

    You must make sure the PCP you choose is a Medicaid or ARKids First provider. If you need a list of PCPs who take Medicaid or ARKids First, call ConnectCare or visit your county DHS office. The list tells you:

    • The doctors name.

    Do I Have To Choose A Primary Care Doctor If I Have Original Medicare

    How to Find a Doctor Who Accepts Medicare

    If you are enrolled in Original Medicare, you generally dont have to choose a primary care doctor. However, its important to make sure the doctor who manages your health care accepts Medicare assignment to keep your out-of-pocket costs low.

    A primary care doctor has three options for caring for Medicare patients:

    • Become a participating provider, which means accepting Medicare reimbursement rates as payment in full
    • Become a non-participating provider, which means accepting Medicare patients but not Medicare reimbursement rates as payment in full
    • Opt out of Medicare entirely

    If you see a primary care doctor who participates with Medicare, you only need to pay 20% of Medicares allowable charges once your Part B deductible is met. If you choose a non-participating primary care doctor, your provider can charge you 15% more than the Medicare reimbursement rate.

    Please also note, If you have Original Medicare, Part A and Part B: With this coverage, you can go to any doctor who accepts Medicare patients. You can use the Physician Compare tool at to help you find a doctor who accepts Medicare assignment. Its a good idea to call the doctors office and verify that he or she will accept new Medicare patients before you make an appointment.


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    Common Medicare Enrollment Periods

    There are two enrollment periods to keep in mind as you approach Medicare age. Your Initial Enrollment Period will be your first opportunity to enroll in Medicare and is based on your date of birth. The Medicare Annual Open Enrollment Period is your annual opportunity to review your coverage and make changes. Both are outlined below.

    You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods . For more details on those Special Enrollment Periods visit

    Tip 3 Review Your Plan

    Your health insurance provider will have information about the physicians that are in their network. The easiest way to find this information is on the health insurance providers website. Most providers have a search function that allows you to find all the primary care doctors in your area. These websites often list additional information, such as quality ratings. If youre more comfortable talking to someone, you can contact the provider on the phone. Their staff should be able to give you a list of the doctors that are close to you.

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    How To Switch Medicare Providers Under Original Medicare

    Traditional Medicare, Part A and Part B, is pretty flexible about the doctors you can visit. Medicare typically covers visits with any doctor who accepts Medicare assignment. That means the doctor must accept the Medicare-approved amount for the service as full payment. She or he isnt allowed to bill you for any amount other than the Medicare deductible and/or coinsurance amounts.

    You generally can switch Medicare providers anytime you want, as long as the doctor accepts Medicare assignment. You may want to call the doctors office before your appointment to make sure he or she still accepts Medicare assignment.

    In fact, even if you switch to a Medicare provider who doesnt take Medicare assignment, it might cost you more but youre generally protected by certain limitations.

    • If legally allowed to do so, the doctor can charge up to 15% more than the Medicare-approved amount for the service. This rule doesnt apply to all Medicare services.
    • The doctor cant bill you for submitting the claim to Medicare, although in some cases you might have to submit the claim.
    • You might have to pay for the entire cost of the visit at the time of service.

    How To Change My Primary Care Physician On Medicare

    Humana and Iora Primary Care have healthcare designed for Medicare

    Working with a primary care physician is essential in maintaining optimal health, preventing illness, and diagnosing conditions before they progress so treatment is most effective. But sometimes, it is necessary to change doctors. Maybe you are moving, your regular physician is retiring, or you simply want a change. Whatever the reason, it is important to know how to change Medicare doctors.

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    How To Change Primary Care Physicians

    You may choose to change your primary care physician for various reasons. Whether you move and require physicians closer to your new homes or you are simply unsatisfied with your current PCP, Medicaid will enable you to change PCPs at any time. The process of finding a new PCP will differ depending on the Medicaid program in which you are enrolled and any supplemental health insurance plans that may cover you. However, anyone must contact their insurance company to notify them of any recent health care changes. Although the process of changing physicians may seem overwhelming, the team at encourages you to utilize the following instructions to facilitate finding ideal PCPs.

    How Do I Choose A Primary Care Doctor

    Most Medicare Advantage plans publish a directory of network providers including primary care doctors. You can often get information about the doctors credentials, areas of practice, and even patient reviews from your plans directory. If the information you want isnt available through the insurer, check the providers website to learn more about the doctor and practice.

    You can also visit the Federation of State Medical Boards and search a doctor to see his credentials and find out whether there are any actions against him. Your state medical board may have additional information about any potential malpractice claims.

    There are also third-party doctor review sites such as and and Yelp where patients can leave reviews on primary care doctors they like or dislike.

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    How To Find A Doctor Who Accepts Medicare

    There are a few simple ways to find a doctor who accepts your Medicare plan:

    • Visit physician compare. The Centers for Medicare & Medicaid Services has a tool that allows you to look up doctors near you and compare them side-by-side.
    • 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.
    • 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, youll 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, 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.
    • 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?

    How To Change Medicare Plans

    DPC doctors and Medicare patients: Read on

    Medicare benefits vary from year to year, so be sure to review your Medicare plan materials annually to ensure that your current plan still meets your needs. You can look over each years Medicare plan at the beginning of October, or we strongly recommend discussing your Medicare options with an insurance agent.

    As you re-evaluate your coverage each year, you may find that you need to change your plan during open enrollment in order to:

    • Keep certain benefits
    • Get a higher quality plan, such as a 5 star plan, if you are currently on a 3 star plan or below
    • Swap your Part D plan to Medicare Advantage in order to keep your in-network provider

    Whether youre already working with a local Medicare agent, have questions about how to find a Medicare agent, or have questions about your options, you can contact our patient enrollment coordinators for assistance. At Iora Primary Care, we work as a team to help you get the most from your insurance plan.

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    Schedule One Last Visit With Your Current Provider

    During this final visit, you should discuss your health conditions, medications and any other concerns with your provider. Take notes. This will give you a snapshot of your current health for your new healthcare provider.

    However, if a final visit isnt possible, or youre leaving your provider because youre unhappy, this step isnt necessary. And, its up to you if you want to discuss your reasons for leaving with your provider. It doesnt have to be a confrontational thing, says Nadkarni. Sometimes, youre just not as satisfied as you would like or youre looking for something different.

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