Once you know what you want from a primary care provider (PCP) or Specialist A specialist is a doctor who specializes in treating only a certain part of the body or a certain condition. For instance, a cardiologist only treats people with heart problems. , you may want a list of providers in your area from which to choose. You may ask for referrals from friends, relatives, coworkers, and/or neighbors. You can also check with your insurance plan, medical societies, hospitals, and accreditation organizations. Be aware that while these sources can provide a list or doctors, they will not necessarily provide quality information.
Note: If you have Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , make sure to see participating providers wherever possible. If you have a Medicare Advantage Plan, make sure to follow your plan’s network rules.
The following sources can help you find lists of health care providers and learn more about their quality.
- Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage). : To find a Provider See Health Care Provider. who accepts Original Medicare, call 1-800-MEDICARE (633-4227) or use Medicare’s Physician Compare tool. If you have a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan, contact your plan for a list of In-Network In-network means part of a private health plan’s network of providers. If you use doctors, hospitals, pharmacies, home health agencies, skilled nursing facilities, and durable medical equipment suppliers that are in your Medicare Advantage Plan or Part D plan’s network, you will generally pay less than if you go to out-of-network providers. providers.
- American Medical Association (AMA): The AMA offers a search engine on its website where you can find doctors in your area by specialty. You can also check on training and board certification.
- The American Board of Medical Specialties (ABMS): ABMS is a nonprofit organization consisting of 24 medical specialty boards that oversee physician certification. You can look up a specific doctor’s credentials or find doctors who are board-certified in a specific specialty in your area. The service is free, but you must sign up before you can do a search. ABMS also publishes a book listing doctors: The Official ABMS Directory of Board-Certified Medical Specialists is available at many hospitals, Social Security offices, Area Agencies on Aging, senior centers, and local libraries.
- Administrators in Medicine (AIM): If you know the name of a particular doctor, you can look them up on AIM’s website. AIM is a group of state medical board directors. You can see physicians’ licensing background and whether or not they have had any disciplinary action taken against them.
While these resources cannot ensure that a particular doctor is the best one for you, they do provide information on a doctor’s knowledge and skills. Some tell you which doctors are board-certified, which means they have completed a training program in a specialty and have passed a board exam on the subject. Keep in mind, though, that while board certification is a good measure of a doctor’s knowledge, it does not guarantee a doctor’s quality or that they will be a good fit for you.