Can I See Any Provider With My Medicare Plan?
Wondering if you can keep your doctor with Medicare? Here’s what you need to know about provider access with different Medicare plans.
Can I keep my doctor? It’s one of the first questions people ask as they approach Medicare eligibility — and for good reason. Your relationship with your healthcare provider is personal, and the last thing you want is for your insurance to complicate that.
In this post, we’ll break down how provider access works under different Medicare insurance plans, so you know what to expect — and how to choose a plan that fits you. This guide is designed specifically for seniors that will be starting to explore their Medicare options.
Let’s simplify the process and get you the answers you need.
Original Medicare vs. Medicare Advantage: The Basics
There are two main ways to get your Medicare coverage — and they offer very different experiences when it comes to choosing healthcare providers.
- Original Medicare (Part A & B):
✅ You can see any doctor or provider who accepts Medicare — no networks, no referrals.
❌ Doesn’t include prescription drug coverage (you’ll need a separate Part D plan). - Medicare Advantage (Part C):
✅ May include extras like vision, dental, hearing, and prescription drugs.
❌ Provider access is limited to networked doctors and hospitals — typically HMO or PPO plans.
So the short answer: Yes, you can see any provider — but only with Original Medicare. If you choose a Medicare Advantage plan, you’ll likely need to stick to a network.
Real-World Example: Meet Carol
Carol is turning 65 in four months. She has been seeing the same family doctor for 20 years and wants to keep that relationship going.
When she started looking at Medicare Advantage plans, she was surprised to find that her doctor wasn’t in the network for most of them. But with Original Medicare, her doctor is covered — as long as they accept Medicare, which they do.
With a little help from one of our licensed consultants, Carol paired Original Medicare with a Medicare Supplement plan and a standalone Part D prescription drug plan. She got coverage she’s comfortable with, and she got to keep her doctor.
3 Steps to Make Sure You Can See the Providers You Want
- Check if Your Doctor Accepts Medicare
You can ask directly or use the Medicare.gov Physician Finder tool. Most providers accept Medicare, but not all are in Advantage plan networks.
- Understand Your Plan Type
- Original Medicare = freedom to choose
- Medicare Advantage HMO = In-network providers only
- Medicare Advantage PPO = more flexibility, but out-of-network costs can be higher when going to provider out of the network
Work With a Medicare Consultant
Trying to compare networks and formularies alone can be overwhelming. A trusted agency (like ours!) can check if your doctors and specialists are covered under the plans you’re considering — and help you explore the available options.
Choosing the right Medicare plan isn’t just about coverage — it’s about keeping the providers you trust.
- Original Medicare gives you the most freedom.
- Medicare Advantage may offer extra perks, but usually comes with network restrictions.
If staying with your doctor is a top priority, we can help you navigate your options and make a plan that fits. You don’t need to figure this out on your own.
Ready to get personalized help?
Our team of licensed Medicare consultants is here to guide you — at no cost to you. Schedule your free consultation today.
Frequently Asked Questions
Can I see a specialist without a referral?
- With Original Medicare: Yes.
- With Medicare Advantage: Usually only if you’re in a PPO. HMOs often require referrals.
What happens if I go out of network on a Medicare Advantage plan?
- You might pay the full cost or higher out-of-pocket fees, depending on the plan type.
Can I switch plans if my provider drops out of my network?
- Yes, but only during certain times of the year, like the Annual Enrollment Period (Oct 15–Dec 7) or the Open Enrollment Period(Jan 1- March 31)
