How To Change Your Medicare Primary Doctor
- Discover the steps for changing your primary care physician or doctor to enjoy continuous health coverage with Original Medicare (Medicare Parts A and B), Medicaid and Medicare Advantage (Medicare Part C) plans.
Building a long-term relationship with a primary care doctor who understands your medical history can lead to better health outcomes. Your doctor plays a pivotal role in your wellbeing as they manage your general healthcare and coordinate specialized care.
However, sometimes it’s time to move on and connect with a new primary care physician. Perhaps you’re moving, changing insurance providers or you’d simply prefer a new provider.
Whatever the reason behind your decision, changing your primary doctor as a Medicare beneficiary may require several steps to ensure you maintain coverage.
Why Change Primary Doctors?
There are several situations where you might need to change your primary care doctor, including if:
- You move far from your doctor’s practice
- Your doctor retires
- Your doctor closes or relocates their practice
- Your insurance provider changes its coverage options or network
- You feel dissatisfied with your current care
Which Medicare Doctors Can You Choose?
Your Medicare coverage impacts which new primary doctor you can select. Here are the options for the various parts of Medicare and Medicaid:
- Original Medicare (Parts A and B): You may choose any doctor who accepts Medicare patients. Compare doctors and their specialties through the official Medicare.gov physician comparison tool.
- Medicaid: You may select any doctor who accepts Medicaid patients. Call the clinic or your state’s Medicaid office to confirm whether your preferred doctor qualifies.
- Medicare Advantage health maintenance organization (HMO) plans: If you have a Medicare Advantage (also called Medicare Part C) HMO plan, you can typically opt for any doctor within your plan’s network. Your plan should publish a list of available doctors online, or you could request a hard copy.
- Medicare Advantage preferred provider organization (PPO) plan: If you have a Medicare Advantage PPO plan, you may be able to choose any doctor accepting Medicare patients. However, you typically save money if you change to a doctor who is part of the plan network. There should be a list of these network doctors online, or available as a hard copy.
How to Change Medicare Doctors
The steps for changing primary doctors vary depending on your Medicare plan.
Original Medicare and Medicaid
Find the doctors near where you live who accept new Medicare or Medicaid patients, including their office locations and specialties. You can visit the Federation of State Medical Boards to check the doctor's credentials and if they have any actions against them.
To change doctors:
- Find a qualifying doctor who is accepting new Medicare or Medicaid patients.
- Contact the doctor’s practice and confirm they are accepting new Medicare or Medicaid patients.
- Make an initial appointment with your new doctor and transfer your care to them.
For seamless continuation of care, it may be recommended to see the same doctor at each appointment. However, Medicare beneficiaries aren’t required to select primary doctors. Because of this freedom of choice, there’s no need to notify Medicare or Medicaid if you change doctors.
You also don’t need to notify your former doctor of your decision to leave, although you may like to. However, it’s prudent to check if your new doctor’s office obtains your medical records or if that is your responsibility.
If they do not provide this service, you should see your previous doctor to request these records and have a health status check before moving to a new doctor.
Medicare Advantage HMO plans
Medicare Advantage HMO members typically must choose primary care doctors from their plan’s network. You can do so by visiting your plan’s website and browsing through the doctors listed in your network. Your insurance company can also provide you with a hard copy through the mail if you prefer.
Take your time to decide and compare each doctor’s credentials and areas of specialty. Some insurers also provide patient reviews that are worth evaluating.
To change doctors:
- Choose a doctor from the network list.
- Ask the practice whether the doctor is accepting new patients and make an appointment if possible.
- Contact your insurance company through the phone number on your plan ID card to notify them of your new primary health care provider. In some cases, you may be able to make the change online.
- Confirm if your new doctor obtains your medical records or if you must coordinate this transfer.
Updating Your Medicare.gov Account
While it’s not essential, you may like to add your primary care doctor’s details to your Medicare.gov account. Doing this can give your new doctor access to tools and services that allow them to effectively manage your care.
To update your details:
- Log in to your Medicare.gov account.
- Click on the Find Care tool on the account homepage.
- Enter your new doctor’s name and location, then click search.
- Click the button with the love heart to add the doctor to your favorites list.
- Click the checkbox to add the doctor as your primary clinician to your favorites list.
After identifying your Medicare plan, the steps for changing your primary care doctor are straightforward. Complete each step to enjoy continuous Medicare and health coverage.