Check the exact doctor, facility and plan.

Original Medicare and plan networks differ

Original Medicare generally allows you to use doctors and hospitals that accept Medicare. Medicare Advantage can have a plan network and other requirements.

A broad statement such as 'we accept Medicare' does not answer whether the office participates in a specific Medicare Advantage plan. Use the complete plan name and the practice location.

Understand HMO and PPO differences

Medicare explains that HMOs generally require network care except for specified circumstances such as emergency or urgent care and out-of-area dialysis. PPOs generally allow out-of-network care for covered services, usually at a higher cost.

Neither label is enough to decide whether a particular provider will see you under the proposed arrangement. Check the plan and the provider, and ask about referrals or authorization for the service.

Protect care already under way

Make a separate list of planned procedures, current specialists, rehabilitation, equipment and recurring treatments. Ask the proposed plan how transitions and existing authorizations would be handled.

For VA-authorized community care, confirm the VA pathway separately. For TFL or CHAMPVA, ask how secondary claims will be handled in addition to checking the Medicare network.

Bring these questions to the review.

• Is this location in this exact plan's network?
• Will you accept me under that plan?
• What approval is needed for my ongoing treatment?
• How will secondary coverage be billed?