Oak Street Health accepts Original Medicare and most Medicare Advantage plans, but coverage varies by location

Oak Street Health is a network of primary care clinics that work with Medicare patients. Whether your plan is accepted depends on which specific Medicare coverage you have and which Oak Street Health clinic location you want to visit. Original Medicare (Parts A and B) is accepted at most locations. Many Medicare Advantage plans are also in-network, but not all of them, and acceptance can differ between clinics in different cities.

The best way to know for certain is to call the specific Oak Street Health clinic you want to use or check their website for your state. Oak Street Health clinics are located in multiple states, and each location may have different insurance partnerships. You can also call your insurance plan directly and ask whether Oak Street Health clinics near you are in-network.

Key Takeaways

  • Original Medicare (Parts A and B) is accepted at most Oak Street Health locations, though you should confirm with your local clinic.
  • Many Medicare Advantage plans work with Oak Street Health, but acceptance varies by plan and by clinic location.
  • The fastest way to confirm is to call the Oak Street Health clinic you want to visit and ask which plans they accept.
  • If your plan is not accepted at your nearest clinic, you can ask your insurance company for a list of in-network primary care doctors in your area.

How to check if your specific plan is accepted

Start by finding the Oak Street Health clinic closest to you. You can search their website by state or city. Once you have the clinic's phone number, call and tell them your insurance plan name and member ID. They can tell you in a few minutes whether that plan is in-network at that location.

If you prefer to check before calling, log into your insurance plan's website and search for Oak Street Health by name or by the clinic's address. Most Medicare Advantage plans and Original Medicare have online provider directories where you can type in a clinic name or location. If the clinic appears in the results, it is in-network for you.

Keep in mind that "in-network" means your plan has agreed to pay the clinic's rates. You may still have a copay or coinsurance at the visit, depending on your plan. Ask the clinic what your out-of-pocket cost will be before your first appointment.

What to do if Oak Street Health is not in your plan's network

If the Oak Street Health clinic near you does not accept your plan, you have two options. First, you can ask your insurance company whether they cover out-of-network visits. Some plans do, though you will usually pay more. Call the customer service number on the back of your insurance card and ask what percentage of the bill you would owe if you see an out-of-network provider.

Second, you can find a different primary care doctor who is in-network with your plan. Your insurance company's website has a provider directory where you can search by location and specialty. You can also call your plan and ask them to send you a list of primary care doctors accepting new patients in your area. Many Medicare Advantage plans have multiple primary care options in most cities.

Original Medicare versus Medicare Advantage at Oak Street Health

If you have Original Medicare (Parts A and B), Oak Street Health clinics generally accept it. However, you will still need to check with your specific clinic location, because coverage can vary. With Original Medicare, you pay a copay at the visit (usually $15 to $25 for a primary care visit), and Medicare covers the rest.

If you have a Medicare Advantage plan, the clinic must be in-network for your specific plan. Medicare Advantage plans are run by private insurance companies, and each plan has its own network of doctors and clinics. One plan might accept a particular Oak Street Health clinic while another plan does not, even if both are Medicare Advantage. This is why calling ahead is important.

Some Medicare Advantage plans include extra benefits like dental, vision, or fitness programs. If you switch to a different plan or clinic, you may lose those benefits. Before you change doctors, check whether your current plan's benefits will transfer to a new provider.

What information you will need when you call

Have your insurance card in front of you when you call Oak Street Health or your insurance company. You will need your member ID number, which is printed on your card. You should also know your plan name — for example, "Humana Gold Plus" or "United Healthcare Advantage."

If you are calling Oak Street Health, also have the clinic's address or location name ready. Oak Street Health has clinics in different cities, and the same plan might be accepted at one location but not another. Telling them which specific clinic you want to visit will give you the most accurate answer.

Setting up your first appointment

Once you confirm that your plan is accepted, call the clinic to schedule an appointment. Tell them you are a new patient and ask what documents to bring. You will typically need your insurance card, photo ID, and a list of any current medications.

Ask the clinic about their new patient process. Some Oak Street Health locations offer same-day or next-day appointments for new patients. When you call, also ask whether there is a copay and what it is, so you know what to bring or whether you can pay by card at the visit.

Frequently Asked Questions

Does Oak Street Health accept Medicaid?

Oak Street Health primarily serves Medicare patients, not Medicaid. If you have Medicaid, you will need to find a different primary care provider. Your state's Medicaid program has a provider directory on its website where you can search for doctors who accept Medicaid in your area.

What if I have both Original Medicare and a Medigap plan?

If you have Original Medicare plus a Medigap supplemental plan, Oak Street Health will bill Medicare first and then your Medigap plan. Call the clinic to confirm they accept both, though most do. Your Medigap plan does not have a network, so as long as the clinic accepts Original Medicare, your Medigap will work there.

Can I see an Oak Street Health doctor if I have a Medicare Advantage plan from a different state?

Medicare Advantage plans usually only cover in-network care in the state where the plan is sold. If you are traveling or have moved, your out-of-state plan may not cover an Oak Street Health clinic in another state. Call your plan to ask about out-of-state coverage before you schedule an appointment.

What happens if I go to Oak Street Health and my plan is not accepted?

If you see a doctor at Oak Street Health and later find out your plan is not accepted, you may receive a bill. Call the clinic and your insurance company right away to explain the situation. Many clinics will work with you to resolve billing errors, especially if you made a good-faith effort to confirm coverage beforehand.

Do I need a referral to see a doctor at Oak Street Health?

Most Medicare Advantage plans do not require a referral to see a primary care doctor. However, some plans require a referral to see a specialist. When you call to schedule your first appointment at Oak Street Health, ask whether your plan requires a referral for any services you need.