Questions to Ask Your Doctor About Medicare
Switching Medicare plans — or enrolling for the first time — affects which doctors you can see and what you'll pay. Before you enroll, have a conversation with your doctor's office. These questions help you verify that a plan actually works with your care team, not just on paper.
Is This Doctor in My Plan?
Network status determines whether you can see this doctor at in-network rates — or at all.
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1"Do you accept [plan name]?" Give them the specific plan name and ID number. "Medicare Advantage" isn't specific enough — there are thousands of MA plans. Their answer:
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2"Are you in-network or out-of-network for this plan?" In-network = lower costs. Out-of-network with a PPO = covered at higher cost. Out-of-network with an HMO = likely not covered except emergencies.
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3"Do you accept Medicare assignment?" If yes, they agree to accept the Medicare-approved amount as full payment — protecting you from surprise charges.
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4"Are you planning to stay in this plan's network next year?" Providers can leave plan networks annually. If they're leaving, you may need to switch plans or find a new doctor.
How Do Referrals Work?
HMO plans require referrals to see specialists. PPO plans don't. Either way, understanding the process saves time and money.
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5"If I need a specialist, do I need a referral from you first?" HMO plans almost always require this. If your plan is a PPO, you can usually self-refer but confirm.
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6"Which specialists in my plan's network do you typically refer to?" Your doctor may have preferred specialists who are in-network. Getting names upfront avoids out-of-network surprises.
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7"How long does it usually take to get a referral processed?" Some offices process referrals same-day; others take 1–2 weeks. Knowing this helps you plan ahead.
Will My Medications Be Covered?
Your doctor can help you navigate formulary issues — including switching to covered alternatives or requesting exceptions.
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8"Are there generic or therapeutic alternatives for any of my medications?" A lower-tier alternative can save hundreds per year. Your doctor can tell you if a generic is clinically equivalent for your situation.
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9"If my plan doesn't cover a medication I need, will you help with a formulary exception request?" Doctors can submit exception requests to the plan explaining why a specific drug is medically necessary for you.
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10"Do any of my medications require prior authorization or step therapy?" Your doctor's office handles prior auth submissions. Knowing which drugs need it helps you plan for potential delays.
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11"Can you send prescriptions to [my preferred pharmacy]?" Confirm your pharmacy is compatible and ask about electronic prescribing, which is faster and less error-prone.
Which Hospitals Can I Use?
Your doctor's hospital affiliations determine where you'll go for procedures, emergencies, and inpatient care.
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12"Which hospital(s) are you affiliated with?" Hospital name(s):
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13"Is that hospital in my plan's network?" An in-network doctor at an out-of-network hospital can create unexpected bills. Verify both.
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14"If I need surgery, would it be done at that hospital?" Some procedures may be done at outpatient surgery centers instead. Confirm where and whether it's in-network.
What Will I Actually Pay?
Even with insurance, out-of-pocket costs vary. These questions help you anticipate bills before they arrive.
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15"What's the typical copay for an office visit with my plan?" Your plan documents list this, but the office can confirm. Primary care and specialist visits often have different copays.
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16"Are there any services you commonly recommend that might not be covered?" Some screenings, lab tests, or preventive services may not be covered depending on your plan. Ask before scheduling.
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17"If I need a procedure, can your office give me a cost estimate before it's scheduled?" Many offices can provide estimates. This is especially important before any non-emergency procedure.
Can I See You Virtually?
Many Medicare Advantage plans now cover telehealth visits. Confirm your doctor offers them and your plan covers them.
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18"Do you offer telehealth/video visits?" If yes, ask which platform they use and whether the copay differs from in-person visits.
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19"For follow-up appointments, can those be done virtually?" Routine follow-ups via telehealth save travel time and are increasingly common for medication management and chronic condition check-ins.
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20"What's the best way to reach your office for non-urgent questions?" Patient portal? Phone? Secure messaging? Knowing the preferred channel helps you get faster responses. Best contact method:
Frequently Asked Questions
How do I find out if my doctor accepts my Medicare plan?
Call your doctor's billing office and give them your plan name and ID number. You can also check the plan's online provider directory at Medicare.gov or the insurer's website. Always verify directly — online directories can be outdated.
What does "Medicare assignment" mean?
When a doctor accepts Medicare assignment, they agree to accept the Medicare-approved amount as full payment. They can't charge you more than the approved amount plus any applicable coinsurance or deductible. Most doctors who see Medicare patients accept assignment. See our glossary for more details.
Can my doctor help me choose a Medicare plan?
Your doctor can tell you which plans they accept, which hospitals they're affiliated with, and how referrals work. They cannot enroll you or recommend specific plans. For enrollment, use Medicare.gov or call 1-800-MEDICARE.
What if my doctor leaves my plan's network mid-year?
If your doctor leaves your plan's network, you may qualify for a Special Enrollment Period (SEP) to switch plans. Contact your plan's member services to understand your options. In some cases, the plan may grant a temporary "continuity of care" exception to finish ongoing treatment.
Compare Medicare Plans in Your Area
See which plans your doctor accepts — search by zip code to find plans available where you live.
Find Plans by Zip Code📋 Enrollment Checklist · Medicare Glossary · Enrollment Dates
About the Reviewer
Wes Ward is the founder of InsuranceDataNow.org and reviews all content for data accuracy and methodology compliance. With 25+ years in data analytics — including work with regulated data at Ancestry.com and Zions Bancorporation — he brings enterprise-level rigor to consumer healthcare tools.