Medicare Coverage and Doctors (Part 1)

Medicare Coverage and Doctors

Senior citizens depend on Social Security and Medicare to meet their financial and medical needs. But now, there is concern among seniors that their doctors and clinics are going to stop accepting Medicare patients. In reality, most doctors accept Medicare patients. Often, a doctor who is not accepting a patient is doing so not because of Medicare but because their practice is full. Why are medical practices filling up with patients?

 

There is a concerning trend of medical students choosing to go into higher-paying specialties rather than general practice. They can earn almost twice as much per year as specialists. Because of this, as few as 3% of medical students choose family practice. As family doctors retire and fewer medical students choose to become family practitioners, a shortage of primary care physicians happens.

 

At the same time, a large number of Baby Boomers are reaching retirement age and Medicare eligibility. So, there is a shortage of doctors just as a large group of people becomes eligible for Medicare. In addition, Medicare reimburses doctors less than insurance companies for younger patients. A doctor can only see so many patients per day, so they try to balance non-Medicare and Medicare patients. A medical practice can only serve a certain number of patients.


Finding A Medicare Doctor


When a medical practice has reached the limit of patients they can handle, they will tell prospective patients they can not take new patients. The office staff might even say they are not taking Medicare patients when they should be saying they are not taking any new Medicare patients.

 

Congress must make changes to the Medicare program to address these problems so older patients continue to get the medical care they need. Medical students must be enticed to go into general medicine or family practice so the shortage of doctors is addressed. Medicare must reimburse doctors at a level similar to non-Medicare patient’s insurance. Since Medicare is paying out more than it brings in right now, funding solutions must be found to keep Medicare viable into the future.


What is Medicare and the Medicare Network?


Medicare is a huge national health insurance network for senior citizens. This program is not limited to one area but covers all of the U.S. Many people are covered by some type of health insurance all of their lives. Many insurance programs are through a person’s employment, such as PPO plans. In addition to basic Medicare, many seniors opt to sign up for a Medicare Advantage plan with a secondary insurance company supplementing Medicare. Medicare plans have networks of doctors and hospitals their clients can use. Clients are required to contact the network before having medical treatment. Doctor’s offices often do this for patients.

 

The Kaiser Family Foundation, after studying recent surveys, has found that fewer than 3% of seniors had trouble finding a doctor when they needed one. This agency has found similar experiences when assisting clients in finding and getting appointments with their physicians. Most doctors accept some form of Medicare. We do research to find out which Medicare plans are accepted by most doctors. Most providers accept either Original Medicare or a Medicare Advantage plan network, or they accept both. Very few doctors fail to accept any form of Medicare.


Finding A Medicare Provider After You Move


Senior citizens often relocate after they retire. They might want to be closer to adult children, move to a warmer climate, or downsize to a senior community in a different part of the country. And, some seniors want to spend a few years on the road as RVers seeing America. After the couple is settled in their new mailing address, they must locate the medical professionals they need.

 

There may be a temporary problem accessing medical treatment until they call around and find new primary physicians and specialists in the Medicare network of providers. It is wise to look for medical providers before one is actually needed. Since there are record numbers of Baby Boomers joining Medicare every day, there is competition for primary care doctors to consider. Most doctors accept Medicare patients if they have room.

 

Since Medicare pays a lower rate of reimbursement than other insurance plans, medical practices might limit the percentage of Medicare patients they see. They must have non-Medicare patients as well as Medicare patients to keep their practices profitable. They will continue to see patients who reach retirement age and switch to a Medicare plan, but they must limit new patients on Medicare to make enough money to keep giving all their patients quality care.

 

Each Medicare patient will have a long list of Medicare providers in the form of a Medicare provider’s book or online. The senior citizen will need to find doctors accepting Medicare in their area and call them to see if they have Medicare patient openings. People who are working with good Medigap agents can ask them to help with locating a physician that accepts Medicare. Once a person has established themselves with the medical professionals in the new location, they are set.

 

I hope you enjoyed reading about Medicare Coverage and Medicare doctors. Please keep an eye out for Part 2 of this blog post, where I will go over finding doctors who accept Medicare. 

Picture of two medicare beneficiaries on a laptop review their Medicare options.

When is the Annual Enrollment for Medicare?

September 7, 2025
Many people find the Annual Enrollment Period quite confusing, so we created an easy-to-follow checklist to help guide you through it. Things to know about the Annual Enrollment Period When is the Medicare Annual Enrollment Period? It is a period that runs from October 15th to December 7th each year. It is important to keep in mind your Medicare Supplement (Medigap) policy will not be affected during this time. Medigap benefits remain the same each year. However, you can shop rates if you're looking for lower premiums. Medicare Advantage plans (Part C) and Prescription Drug Plans (Part D) DO change. These plans must renew their contracts with Medicare annually, which allows them to change premiums, co-pays, networks and drug formularies. Therefore, it is essential to review and understand any upcoming changes to your plan. The Annual Enrollment Period (AEP) is your opportunity to decide whether to keep your current plan or switch to a new one. 5 Steps to take during the Annual Enrollment Period 1. Review your annual notice of change letter Your plan is required to send you an Annual Notice of Change packet by the end of September. Take the time to review any upcoming changes to your plan and decide if you want to explore new options for more benefits or lower premiums. If you are satisfied with your current plan, no action is needed. It will automatically renew on January 1st. 2. Compare your prescription drug costs Your plan may change the costs of your prescription medications each year. It is recommended to review your Annual Notice of Change letter to ensure that all of your out-of-pocket drug costs remain affordable. 3. Verify that your doctors are in network Medicare Advantage (Part C) plans have networks. Each plan offers a directory of network providers you can search to see who participates in the plan’s network. Doctors can leave a Medicare Advantage plan network at any time. Even if you aren't changing plans, make sure to check that your doctors are still in network with your current plan. 4. Decide if your plan still meet your healthcare needs Medicare health plans can introduce new benefits and services each year. These benefits may include dental, vision, hearing, fitness memberships, transportation services, among other programs that can help you save on your Medicare premium. Most importantly, comparing these new offerings can help you find the coverage that’s most suitable for your needs. Last but not least - Don’t miss the deadline 5. Schedule a No-Cost Annual Medicare Review Now that you know how the Medicare Annual Enrollment Period (AEP) works, it is time to schedule a date on your calendar to review your choices. Our team at Seniors Health can help you weigh your options, so you can make an informed decision. Representing dozens of top-rated carriers, we can help you compare plans, run quotes and find the most cost-effective plan in your area. Best of all - Our service is free and our team is here to ensure that you are getting the most out of your Medicare coverage. Please do not hesitate to reach out. You can call Monday through Friday - anytime from 9:00 am to 5:00 pm at 855-278-2700. We hope you found this information helpful and we look forward to assisting you. Have questions? Contact a Seniors Health agent today and let us know how we can help.
Diagram of the 4 parts of Medicare (Part A, B, C and D), including icons representing each part.

What are the 4 Parts of Medicare?

July 21, 2025
Medicare is the federal health insurance program for people 65 and over, some younger with disabilities and those with End Stage Renal Disease. Medicare is a different program from Medicaid, which offers healthcare and services to those who meet the qualified lower income requirements. Anyone receiving Social Security Disability (SSDI) for 24 months, will also become eligible for Medicare. When discussing some of the Medicare basics, It’s important to know that there are 4 Parts of Medicare and each part works in a unique way to help cover your healthcare expenses. What Is Medicare Part A and What Does It Cover? Medicare Part A is inpatient and hospital insurance. Part A helps cover: Inpatient hospital care Skilled nursing facility care Hospice care Some home health care What is Medicare Part B and What Does It Cover? Medicare Part B is outpatient medical insurance. Part B helps cover: Services from a doctor Outpatient care Durable medical equipment Preventative services Some home health care What Is Medicare Part C? Medicare Part C (Medicare Advantage) are privately managed, federally approved Medicare plans. Part C plans combine the benefits of Part A and B into one plan and may also include: Prescription drug coverage Dental, vision and hearing coverage Wellness programs and telehealth services What Is Medicare Part D? Medicare Part D plans provide beneficiaries with privately managed, federally approved prescription drug coverage. Medicare Part A and B do not offer prescription drug coverage, so Part D helps: Manage prescription drug costs Provide lower cost-sharing for in-network and preferred pharmacies What does Medicare Pay? Medicare generally covers 80% of your Part A and Part B medical costs. You are responsible for the remaining 20%. There is no limit on what you pay out of pocket, unless you have Medicare Supplement coverage, also known as Medigap. You could also choose to get your coverage through a Medicare Advantage plan, also known as Part C. It is important to understand how each of these coverages work, when making a decision on how you would like to receive your benefits. New to Medicare with Employer Coverage? You should consider whether it makes sense to keep your employer coverage alongside Medicare or if switching to Medicare as your primary insurance would be a better option. A few key questions would include: How large or small is the employer? How much is your monthly premium? Would you like to have more freedom to choose any provider that accepts Medicare? When it comes to Medicare, there is no one size fits all. Knowing your situation and what you find important, provides answers that help determine which road may be more suitable for you. Avoid Costly Medicare Mistakes - Get Expert Advice We understand that learning about Medicare can seem confusing. Especially knowing when and how to sign up for each part, to ensure you don’t miss any important deadlines. This is where our team of friendly agents can help. To learn which coverage options best suit your needs and how to avoid unexpected medical costs, contact us for a no-cost personalized review.
An image of a calendar to help people understand the Medicare Enrollment Period Dates.

What are the Enrollment Periods for Medicare?

June 27, 2025
When is the Initial Enrollment Period? (IEP) The Initial Enrollment Period begins 3 months before your 65th birthday month, the month of and 3 months after. The Initial enrollment period is a 7-month window where you enroll into Medicare for the first time. You can choose to enroll in Medicare Part A and/or Part B. You may also be eligible to enroll into a Medicare Advantage Plan or Part D Drug Plan. What if I missed my Initial Medicare Enrollment Period? Missing your initial enrollment period could negatively impact you financially. By not enrolling on time, you may incur a late enrollment penalty. This penalty amount can increase over time or for as long as you are not receiving coverage. If you missed your Initial Enrollment Period, you would have to wait until the General Enrollment Period to be eligible to enroll. When is the Medicare Annual Enrollment Period? (AEP) Medicare’s Annual Enrollment Period begins on October 15th and ends on December 7th. During this time, Medicare beneficiaries can enroll, change or dis-enroll from a Medicare Advantage Plan or Part D (Prescription Drug Plan). If you were not able to enroll in a Medicare plan during your Initial Enrollment Period, this would be your opportunity to explore your options before you miss the deadline. It’s very important to review your current coverage annually to ensure that your health needs are being met for the following year. Do I need to re-enroll in my Medicare plan every year? Generally, you will be automatically enrolled into your current Medicare plan every year, unless you feel that your Medicare plan no longer meets your budget or specific goals. If you feel that you are missing important benefits such as dental, vision or hearing, then this would be the time of year to compare your options. During this time, you may also find Part D plans that offer lower prescription drug costs. Whether you choose to make changes or not, this is the time to make sure that you are receiving all the benefits being offered in your area and to ask questions (before the December 7th deadline). When is the General Enrollment Period? (GEP) The General Enrollment Period starts on January 1st and ends on March 31st. During this time, you could enroll into Original Medicare, if you missed your Initial Enrollment Period and did not qualify for a Special Enrollment Period. Keep in mind that although you may sign up for Original Medicare, you may be subject to late enrollment penalties. Also, if you would like to enroll into a Medicare Advantage or Medicare Part D (Prescription Drug coverage) during this time, you will have to wait until the Annual Enrollment Period to be eligible. When is the Medicare Advantage Open Enrollment Period? (MA OEP) The Medicare Advantage Open Enrollment Period begins on January 1st and ends on March 31st. This Open Enrollment Period is for beneficiaries who are already enrolled in a Medicare Advantage Plan and want to leave or change to a different Medicare Advantage Plan. Also, you may switch back to Original Medicare with or without Part D drug coverage. However, you will not be able to change from a Part D to another Part D (Prescription Drug) Plan. What is a Special Enrollment Period? (SEP) The Medicare Special Enrollment Period (SEP) is an 8-month period that begins the month you or your spouse retire from work, or the month that your group coverage ends (whichever comes first). If you’ve had health coverage through your employer, you can enroll in Part A and/or Part B, since you’ve had creditable coverage through a group health plan. There are certain circumstances that can make you eligible for a Special Election Period. If you have moved outside of your plan’s service area, you will have two months to make changes to your coverage. When is the Medigap Open Enrollment Period? This period automatically starts the first month you have Medicare Part B and you’re 65 or older. During this 6-month Medigap Open Enrollment Period, those looking to buy a Medigap Policy will generally get better pricing and have more available choices. During this period, you can get a Medigap policy sold in your state, even if you have health problems. After this enrollment period ends, you may not be able to buy a Medigap policy if you are unable to pass a medical underwriting review. Can I change Medigap plans anytime during the year? You may be able to change your Medigap plan during the year, but this depends on your overall health and if you are able to qualify for a new policy. If you haven't compared plans or premiums in a while, doing so could lead to a great opportunity for savings. Get Help with Your Medicare Options We understand that everyone’s situation is unique and it can be a bit overwhelming to make this important decision on your own. This is where we can help. We are experts when it comes to simplifying Medicare and we provide each beneficiary with a no cost Medicare review. This helps us understand your specific health needs, budget and we can help determine what may be the perfect plan for you. Whether you are retired, about to retire, new to Medicare or currently looking at your options, we’d love to help and answer all your questions and help you understand your choices.