Medicare FAQ

Can I Keep My Doctor with Medicare Advantage?

It depends on whether your doctor participates in that specific plan's network. Unlike Original Medicare, Medicare Advantage plans typically use HMO or PPO networks — your doctor must be in-network for the plan to cover the visit at the normal cost.

Why Does This Work Differently Than Original Medicare?

Original Medicare (Parts A and B) is accepted by any doctor or hospital in the country that takes Medicare — there's no network to worry about. Medicare Advantage plans are run by private insurance companies, and most build a network of contracted providers, similar to employer health insurance. Seeing an out-of-network provider on an HMO plan usually isn't covered at all; on a PPO plan it's typically covered but at a higher out-of-pocket cost.

How Do I Check If My Doctor Is In-Network?

• Look up the specific plan's provider directory — not just "does this carrier work with my doctor," since networks vary plan-by-plan even within the same carrier.
• Confirm directly with your doctor's office, since online directories aren't always current.
• Recheck every year during AEP — plan networks can and do change from one plan year to the next, even if you don't switch plans.

What If My Doctor Isn't in Any Available Network?

If keeping a specific doctor without network restrictions matters most to you, Original Medicare paired with a Medigap supplement may be a better fit than Medicare Advantage — Medigap doesn't use networks at all. It's worth weighing that flexibility against Medicare Advantage's typically lower premiums and bundled extra benefits.

What's the Difference Between HMO and PPO Networks?

HMO (Health Maintenance Organization) plans generally require you to use in-network providers and get a referral to see specialists, with little to no coverage for out-of-network care except emergencies. PPO (Preferred Provider Organization) plans give you more flexibility to see out-of-network providers, usually at a higher cost, and typically don't require referrals for specialists. If seeing specialists directly matters to you, that flexibility is worth weighing against a PPO's usually higher premium.

Does This Apply to Specialists and Hospitals Too?

Yes — network rules apply to every type of provider in your plan, not just primary care doctors. That includes specialists, hospitals, labs, and imaging centers. Before enrolling, it's worth confirming that your full care team, not just your primary doctor, participates in the plan's network.