If your doctor or other provider is part of an ACO, you still have the right to visit any doctor, hospital, or other provider that accepts Medicare at any time. Moving from private insurance to Medicare is a great blessing for many people. With the excessive costs of insurance premiums, the government-funded insurance policy goes a long way in providing health insurance coverage to many people who didn't pay for it before age 65 or who were just getting ahead with their coverage plan. However, many older people ask themselves the same question when they ask the change.
There are a few things that come into play when choosing a doctor for your Medicare plan. At Common Health, we want to help you understand the nuances of choosing a doctor with Medicare, so we have four things to consider as you do so. With Original Medicare (Medicare Part A and Medicare Part B), you can visit any doctor, specialist, participating provider, or hospital that accepts Medicare. Because there are no network restrictions, you have extensive access to healthcare providers across the country. Original Medicare allows you to get care from any doctor or specialist who accepts Original Medicare or Medicare Advantage (Part C).
Many doctors work with Original Medicare and Part C plans. When you sign up for Medicare, your ability to continue receiving care from your current doctor depends on whether you accept an assignment or are part of your plan's network, depending on your specific plan. By ensuring adequate reimbursement for services, you can ensure you get the best possible health outcomes by carefully considering your plan options and making sure your doctors are covered. If your doctor is participating in this model, you will receive a letter notifying you that your provider is working with a responsible care organization to improve your care through the ACO REACH model.
Otherwise, you can search for other specialists or primary care doctors who accept Medicare in the directory of Medicare providers available under Medicare. An Accountable Care Organization (ACO) is a group of doctors, hospitals and other health care providers who accept Original Medicare and work together to coordinate their health care. In addition, a doctor or other provider who is part of an ACO may receive approval to send their patients to a skilled nursing facility or rehabilitation facility, even if they haven't been hospitalized for 3 days first, which is often a Medicare requirement. Getting care from an out-of-network doctor with a PPO plan can cost you more than getting care from a network doctor. To qualify for this benefit, your doctor or other provider must decide if you need care in a skilled nursing facility and meet other eligibility requirements.
According to a health maintenance organization (HMO) plan, receiving care from an out-of-network doctor means you may have to pay the full cost of care.
