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How to Get Information on Medicare Provider Networks

Find out which doctors are covered by your plan.

I heard that some Medicare Advantage plans are cutting back on their provider networks for 2014. How can I find out if my mother’s doctors will still be in her network? Can she change plans if they are leaving?

SEE ALSO: 10 Things to Know About Medicare

The Thanksgiving holiday is the perfect time to help your parents with questions about their Medicare plans. Open enrollment for Medicare Advantage and Medicare Part D prescription drug plans runs until December 7, 2013, allowing you to change plans for 2014 for any reason.

Many Medicare Advantage plans’ Web sites include databases that make it easy to look up which providers are covered in your area. But physicians and hospitals can leave or join a managed care network at any time, so it’s also a good idea to call the health plan and the doctor’s administrative staff to verify that the doctor will still be included in 2014. When contacting the plan, ask about the location nearest your mother. Many physicians have multiple offices and practice with more than one physician group.

If your mother doesn’t switch plans during open enrollment, she may still have a chance to make changes after that. You can switch to a Medicare Advantage plan with a five-star rating anytime during the year, although in many parts of the country there are no five-star plans available. See Some Can Switch Medicare Advantage Plans Mid-Year for details. Also, she can switch from a Medicare Advantage plan back to traditional Medicare from January 1 to February 14 (and she can get a Part D plan during that time, too) if she wants to leave the plan before the next open-enrollment period in the fall. (However, you cannot switch from one Medicare Advantage plan to another during this period, other than into a five-star plan.) If she does switch to traditional Medicare, she should also consider getting a medigap policy to help pay for co-payments and deductibles. Caveat: She could be charged more or rejected for medigap coverage because of her health at that point. See How to Find a Cheaper Medigap Plan for more information about medigap policies.


For more information about what to look for when choosing a Medicare Advantage or Part D plan during open enrollment this year, as well as changes that could affect your costs, see Time for Medicare Open Enrollment. For details on the coverage these plans provide, see Medicare Advantage Plans Can Cut Costs and Hassle. Also see our Navigating Medicare Special Report for more information about Medicare Advantage, Part D, medigap and other Medicare-related issues.

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