Original Medicare vs. Medicare Advantage: Checking a Doctor's Network
With Original Medicare, you can see any doctor or hospital that takes Medicare, anywhere in the U.S. With a Medicare Advantage plan, you may need to use doctors in the plan's network and service area for non-emergency care. Our listings don't show plan networks, so check with your plan and the office.
The Main Difference
Medicare.gov compares the two this way: with Original Medicare, you can use any doctor or hospital that takes Medicare, anywhere in the U.S. With Medicare Advantage, you may need to use doctors and other providers who are in the plan's network and service area for non-emergency care.
A doctor can appear in the Medicare file and still be outside your plan's network. The CMS file on our pages doesn't list networks.
This guide explains how to find and check care. It can't tell you which doctor or treatment is right for you. Your doctor or plan can.
How Plan Types Differ
| Plan type | Usual rule |
|---|---|
| HMO | Care generally comes only from doctors and hospitals in the plan's network. Exceptions include emergency care, out-of-area urgent care and temporary out-of-area dialysis. Some HMOs are Point-of-Service plans, which may allow some out-of-network services at a higher cost. |
| PPO | You can generally go out of network for covered services, but you'll usually pay more. |
| MSA | These plans generally don't have a network of providers. |
Your plan's own documents decide what applies to you.
How to Check a Doctor
- Find your plan's name and member number on your card.
- Look the doctor up in your plan's directory, or call the number on your card.
- Call the office as well. Ask, "Are you in network with [plan name] this year? Are you taking new patients with it?"
- Write down who you spoke to and the date.
If you live in two states, see seeing doctors in two states. Directories can be out of date, including plans' own and ours, so it helps to ask both sides. For help with coverage questions, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Common Questions
Does this site show which plans a doctor accepts?
No. The public file doesn't list plan networks.
Is a doctor who accepts assignment always in my plan's network?
No. Assignment is an Original Medicare term, and a plan's network is separate. Ask your plan.
Which is better for me?
We can't say, and this site doesn't give that kind of advice. 1-800-MEDICARE can explain your options.