Finding the right doctor

for your Medicare needs

Finding a doctor you can trust is vital for your health and well-being. Your Medicare provider can help you find a quality health professional who accepts Medicare so you’ll pay less for your health services.

Visit The Medicare Website

Physician Compare is an online database of health care professionals and groups on the Medicare website. This database was created by the Centers for Medicare & Medicaid Services in December 2010 to fulfill part of the Affordable Care Act of 2010.

You can use Physician Compare to complete a Medicare doctor search for health professionals enrolled in Medicare using a range of criteria, including:

Health care specialty
Medical condition
Body part affected
Location
Clinician’s name
Health care group name
To start searching, enter your zip code, city, and state, address, or landmark in the location field. Then enter a search term into the website and click search.

Performance scores are one of the most useful features of Physician Compare. They will help you choose the best doctor or health care group, not just the most affordable one. Performance scores are presented as stars and a percentage. The greater the number of stars and percentage amount, the better care doctors and health care groups give their patients. It’s important to note that not all doctors and health care groups listed on Physician Compare have performance scores. Not having a performance score is no indicator of a doctor or health care group’s quality.

Some healthcare groups listed on Physician Compare also have patient survey scores. These scores are also expressed as stars and a percentage. The higher the number of stars and percentage amount, the greater the number of patients that felt positively about their dealings with the health care group.

Physician Compare is updated regularly. However, information about health care providers can change at any time. For this reason, you should always call a new doctor before visiting to confirm that he or she accepts Medicare assignment and new Medicare patients. You should also confirm that the address Medicare has on file is correct.

Call The Medicare Helpline

If you feel more comfortable talking to a real person, you can call the Medicare telephone helpline: 800-MEDICARE (800-633-4227). Telephone representatives are standing by to make recommendations and answer questions about health professionals in your local area participating in the Medicare program. They will happily create a custom list of clinicians most relevant for your needs. While you’re on the phone, you can also ask these support workers other questions you might have about your Medicare coverage and claims.

Understanding Medicare Assignment

Medicare can help you find health professionals who treat people who are covered by Medicare. However, some Medicare doctors don’t accept Medicare assignment.

Health care professionals who accept Medicare assignment accept the Medicare-approved amount as full payment for Medicare-covered services.

When you visit a doctor who accepts Medicare assignment:

You’ll only pay the Medicare deductible and coinsurance amount.
Usually, the doctor will ask Medicare to pay its share before you need to pay your share.
The doctor will submit your claim to Medicare at no additional cost to you.
You’ll usually have less out-of-pocket expenses.

If you visit a doctor who doesn’t accept Medicare assignment, known as a non-participating provider, then:

You might need to pay the entire amount of your health care services as soon as you receive them.
The doctor should submit a claim to Medicare for any Medicare-covered services you’ve received. However, in some cases, you may need to submit your own claim using Form CMS-1490S.


BONUS: Will my doctor accept my Medigap plan?


You may ultimately pay up to 15 percent more than the amount non-participating providers are paid (95 percent of the fee schedule amount) for your Medicare-covered services.

Most healthcare professionals you’ll find through Medicare accept Medicare assignment. However, you should always check to make sure, especially if the doctor is listed on Physician Compare as “May accept Medicare assignment.”

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