Do I get different care or see different doctors if I join a specific health plan or Medicare Advantage Plan?

Most insurance companies and health plans have their own lists of physicians and other providers. They also have preferred hospitals. Although you might be allowed to go out of network and find your own doctor, the payments out of your own pocket can be substantially higher if you do so. If you have Medicare as primary coverage and a secondary policy, then you can see any physician or provider who accepts Medicare. Although some physicians are no longer accepting new Medicare patients and some physicians do not participate in Medicare at all, the majority of physicians still do accept Medicare patients. Most of them are “participating providers” in Medicare, which means they accept the Medicare fee.

Some physicians participate only in Medicare Advantage Plans and they do not accept “straight Medicare patients.” Other physicians accept Medicare patients and they do not participate in Medicare Advantage Plans.

Since your care is directed by your physician or provider, then your health care will be determined largely by the physicians in charge of your care. In most cases there is no significant difference in your care. However, some physicians and providers tend to order a large number of diagnostic studies, particularly if doing so helps to generate income for the group in which they participate. Other physicians do not like to order diagnostic studies if doing so could minimize the profit of the company with which they are associated.