Medicare and Networks, how does it all work? In the world of Medicare you have several choices, but the first is to decide whether to go with “Traditional” Medicare or with a Medicare “Advantage” plan. What doctors you can go to will be highly impacted by this decision.
Traditional (Original) Medicare
With Traditional Medicare (also called Original Medicare) you can go to any doctor in the nation that accepts Medicare. That’s typically quoted as 85 – 90% of the doctors and facilities out there.
On exceedingly rare occasion I hear people say that they cannot find a doctor that accepts Medicare. Many times the doctor that they have checked with does, in fact, accept Medicare, but has decided to cap their Medicare patient load. That’s their decision. There is no rule that says they have to do that, but it is allowed. Many doctors don’t cap the Medicare part of their business.
In any event it would be difficult to find an private carriers network that equaled 85 – 90% of the doctors and facilities out there. Medicare Advantage plans are private carriers and they do have networks that you have to use. So what is it going to be? 85 – 90% of the doctors and facilities out there or an Insurance company based network? It’s your decision.