Navigating Medicare at 65: Ensuring Your Doctor Stays In The Picture


The majority of doctors in the United States accept Medicare. However, before turning 65, your clients should establish whether their doctor accepts Medicare, as some doctors who accept Medicare may not accept new Medicare patients. It’s also important to examine if they’ll be enrolling in Original Medicare, Medigap, or a Medicare Advantage Plan, as this can affect the choice of doctor.

Original Medicare allows clients to keep their doctor as long as they accept Medicare assignment and accept new Medicare patients. A client does not have to choose a primary care doctor, and a referral is not needed to see a specialist.

However, it is always a good idea to check with the doctor to see if Medicare assignment is accepted and they the doctor is currently accepting new Medicare patients.

A MediGap (sometimes called “supplement”) plan allows clients to receive medical services from any provider in the United States who accepts Medicare.  If the doctor accepts Medicare, the MediGap plan will often pay the doctor directly.

Most doctors participate in the Medicare program, therefore Medicare patients can maintain their doctor as long as the physician takes part in the Medicare program.

For HMO Medicare Advantage plans, using in-network healthcare providers is typically required. Going out-of-network may result in uncovered costs. Medicare Advantage plans with a PPO feature offer more flexibility but still require checking to see if the your doctor is in-network. Before choosing a plan, requesting a provider network listing can ensure the a doctor is in the network. Checking the network annually is important since providers in the network may change.

As your clients approach he age of 65 and consider their options for Medicare, it’s important to assess their healthcare needs and resources before choosing a plan that best aligns with their preferences and their ability to keep their current doctor.

A certified Medicare advisor can assist in providing coverage options that prevent any interruption in key healthcare relationships. 

Have Medicare questions? Contact Dan Griset, CPS’s certified in-house Medicare advisor, at (949) 225-7144,, or schedule a call HERE.