Can Medicare Restrict Who And Where I Receive Care From?

Understanding Medicare coverage can be complicated, making it difficult to know where to start.  If you’re feeling overwhelmed by the different policies available, don’t hesitate to make an appointment with an insurance agent that can answer your questions and provide more information.  At Turning 65 Solutions, we prioritize our clients and ensure that they’re making the right choices when it comes to Medicare enrollment.

Medicare policies

There are two main types of Medicare policies.  Original Medicare is what many are automatically enrolled in.  Medicare Advantage policies are the alternative.  They’re sold through private insurance companies and allow beneficiaries to design their own individual coverage.  However, to enroll in Medicare Advantage, you must first be enrolled in Original Medicare.

Medicare coverage

An individual’s Medicare coverage will depend on which type of policy they’re enrolled in.  Because Original Medicare doesn’t allow beneficiaries to choose many aspects of their policies, the coverage is standardized.  Medicare Advantage does allow for some flexibility, so its coverage has many more possibilities and varies.

Medicare cannot restrict what medical professionals you receive care from.  However, if you go to a provider that does not accept Medicare, you may be required to pay some, or all, of the costs out-of-pocket.  This is incredibly important to keep in mind.

Original Medicare

Certain medical professionals accept Medicare.  If you’re enrolled in Original Medicare, you can receive care from any medical professional or facility that accepts Medicare, and the costs will be covered as dictated by your policy.  Those enrolled in Original Medicare are not required to choose a primary care doctor, so this allows for a degree of freedom when it comes to selecting who you’ll receive care from.

Medicare Advantage

Medicare Advantage provides network coverage.  The various types of Medicare Advantage policies allow differing degrees of freedom when it comes to providing coverage when receiving care or treatment from specific networks.  If you go outside of the plan’s network, such as with an HMO, you will most likely have to cover the costs yourself.  If you have a PPO plan, you can receive coverage by going out-of-network, but you will pay less if you were to go to a provider within their network.  

Understanding the network coverage system is important in making sure you’re using your policy to its full extent and not spending more than you need to.

Understanding your policy

Making sense of your individual policy is essential in making the right selection and picking the right providers.  Before you enroll, ask all your questions and get the information you need to make an informed choice.  Being able to select providers is important, as is understanding how much coverage your policy will provide you.

If you’re not sure about the details of your policy or haven’t yet enrolled and are wanting to learn about the options, give us a call.  At Turning 65 Solutions, it’s our goal to ensure that each of our clients has a wealth of information, as well as all their questions answered.  When you work with our team at Turning 65 Solutions, you’re guaranteed to understand your policy and be able to maximize your coverage.

Turning 65 Solutions can help you plan for the future.