One of the “Frustrating Flaws” about Medicare you note in your book is the inability to look up doctors, hospitals and other healthcare providers on Medicare.gov.
I’m shopping around for a new Medicare Advantage plan and am having a really hard time finding one that has all my doctors in-network. How do I do this? Is there an easier way of finding which Medicare insurance companies have my doctors in their Medicare Advantage network?
Thanks for the question and of course, for buying my book! For context, if you’re planning to buy a new Medicare Part D Prescription Drug Plan (PDP) on Medicare.gov, it’s pretty much the easiest DIY enrollment tool around.
Overall, entering your ZIP code for location, adding your prescriptions, and searching for preferred pharmacies is pretty straightforward on Medicare.gov. If a stand-alone Medicare PDP is all you’re shopping for, it’s probably more convenient than using a Medicare insurance agent or Medicare insurance company website to buy one. Medicare lets you enter your prescriptions into their Plan Finder tool, and you can add up to five of your preferred pharmacies. They even have a nice map tool you can use. If you want to find a pharmacy, you’d do this as the very last step in the shopping process. I cover that entire process in chapter nine of the book.
But that wasn’t your question. You’re trying to look up doctors and hospitals for Medicare Advantage plans on Medicare.gov and you’re right – it is frustrating. That’s because you can’t do it.
Medicare.gov Doesn’t Allow You to Search for Medicare Advantage Providers
I call this a “Frustrating Flaw” in my book, and in my opinion, it’s a massive gap in the usability of the entire shopping experience on Medicare.gov.
If you’re looking at Medicare Advantage plans on Medicare.gov, you cannot look up your providers. You can’t look up any providers. It’s not like looking up pharmacies. You have zero ability to enter your doctors and preferred hospitals on Medicare.gov and then sort by those doctors to find the Medicare Advantage plan that covers them all. This is a huge miss and a major flaw of the Medicare.gov website.
One of the free checklists I offer as a thank-you for signing up for the Prepare for Medicare newsletter is the Buying a Medicare Advantage checklist. The very first thing I recommend you check on that checklist is making sure your doctors are in the insurance company’s provider network. Also, is your preferred hospital in the insurance company’s provider network? Even if you think they are or were recently – especially for doctors you see often, it’s best to actually call their offices to double check. Doctors and hospitals enter and leave Medicare Advantage plan networks all the time, especially at the end of the year. If your preferred doctors, hospitals, outpatient facilities or other healthcare providers aren’t in the Medicare Advantage plan network you have or are considering buying, my advice is to find a plan that has all of them in the network. It’s going to take some work, but it will be worth it.
If You Can’t Look Providers up on Medicare.gov, How Do You Do It?
To look up Medicare Advantage providers, you have essentially three options.
- First narrow down your preferred Medicare Advantage plans on Medicare.gov, then research network providers on the Medicare insurance company websites.
- Call your doctor’s offices and ask for a list of Medicare Advantage insurance companies they contract with. Be specific; make sure to confirm they’re in the Medicare Advantage network, not just in a network for other types of insurance plans from the same company.
- Call an online Hybrid insurance agency or use a local Medicare insurance agent for help. If you choose this option, the checklists on my website PrepareforMedicare.com will come in handy and save you some time.
You can find a short list of major Medicare insurance companies as well as Hybrid online insurance agencies in the Helpful Links section of the Prepare for Medicare website!
Here’s the link:
Christine, I hope this helped!
I love answering Medicare questions. Send me yours at firstname.lastname@example.org and I’ll pick a few for a future video or blog post!
Until next time – To your wealth, wisdom and wellness!
Author Bio: Matt Feret is the author of the Prepare for Medicare book series and launched prepareformedicare.com to help people get objective answers to questions about Medicare. He’s also the host of The Matt Feret Show.
He’s held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development and strategy for over 20 years. Matt holds a BA from Virginia Tech and an MHA from Washington University in St. Louis.
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