Can I Keep My Doctor With Medicare?

Additional questions

If the office names a medical group, these are the usual Los Angeles County patterns. A group can handle referrals on one plan and not on another. This is not a list of who is in a plan.

Group handles referralsOn many Los Angeles County HMO contracts, the group handles referrals and prior approval. Another plan can leave that work with the plan.Examples: Optum, HealthCare Partners, Regal, Lakeside, Heritage, AppleCare, Allied Pacific, Prospect, Greater Covina, Axminster, Seoul, Preferred IPA, HealthCare LA, Global Care, and Angeles IPA.

Only some jobs moveThe plan keeps some jobs and gives others to the group. Which ones depend on the plan. Ask who approves a referral on your card.Examples: AltaMed, Facey, and UCLA.

Hospital medical groupThese doctors work for a hospital system. When you need a referral or an approval, you usually ask the Medicare Advantage plan, not the medical group.Examples: Cedars-Sinai, USC Care, Keck Medicine, Providence, PIH Health Physicians, MemorialCare, Torrance Memorial, and City of Hope.

Plan and doctors togetherThe health plan and the doctors are one system. Another Medicare Advantage plan does not assign this group.Examples: Kaiser Permanente.

Original Medicare

You can generally keep a doctor who accepts Original Medicare and is taking patients. Ask whether excess charges apply. A small number of doctors opt out of Medicare. If the office says they do not take Medicare, this doctor is not an option under Original Medicare.

Medicare Advantage

You can keep the doctor only if that doctor, at that address, is in that plan’s network this year. “We take Medicare” means the office bills Original Medicare. It does not mean the office takes a Medicare Advantage plan.

A Medicare Supplement

A Supplement does not create a network and it does not add doctors. It helps pay costs after Original Medicare. The office still has to accept Original Medicare.

Why the plan count is not the first step

In 2027, CMS lists 124 Medicare Advantage plans in Los Angeles County. Most are HMOs. Only 6 are PPOs. Five of those plans do not include drug coverage. The count does not tell you whether your doctor is included. You need to ask the doctor's office questions about the plans they accept.

Common questions

The office said they take Medicare. Does that mean every Advantage plan?

No. “We take Medicare” means the office bills Original Medicare. It does not mean the office takes a Medicare Advantage plan. Ask which plan names they take at that address this year, then check those names on Medicare.gov.

My specialist is in a different medical group. Does that matter?

It can. Many Los Angeles County HMO plans also use a medical group. A specialist can be on the plan and still be outside your group. Ask the office whether that specialist is in the group, and whether you need a referral.

Can I keep my doctor with Medicare?