Gastroenterologists That Accept Medicare in New York

Steps to Find a Gastroenterologist at Digestive Disease Care Who Accepts Medicare

1. Visit Medicare’s Website

• Go to medicare.gov.
• Use the Care Compare tool.

2. Search by Location & Specialty

• Enter your New York zip code.
• Select “Gastroenterologist.”

3. Look for Digestive Disease Care

• Review the list of Medicare-accepting gastroenterologists.
• Check if Digestive Disease Care is included in your area.

4. Confirm With Medicare Directly

• Call 1-800-MEDICARE for assistance in locating Digestive Disease Care gastroenterologists.

5. Check With Your Insurance Plan

• If you have Medicare Advantage (Part C), review your plan’s provider directory or call your insurer to confirm coverage at Digestive Disease Care.

6. Ask Your Primary Care Doctor

• Request a referral to Digestive Disease Care gastroenterologists if your plan requires it.

7. Contact Digestive Disease Care Directly

• Call our office to verify Medicare acceptance and schedule your appointment.

If you have Original Medicare (Part A and Part B), you generally do not need a referral to see a specialist such as a gastroenterologist. This means you can contact Digestive Disease Care directly to schedule your appointment, provided your coverage is active and we accept Medicare. This makes the process simple and allows you to get the care you need without extra steps.

For those with a Medicare Advantage Plan (Part C), the requirements depend on the type of plan you have. Many HMO plans require a referral from your primary care doctor before you can see a specialist, while PPO plans often give you more flexibility and may not require a referral. To avoid unexpected costs or delays, it’s important to review your specific plan’s rules or call your insurance provider for confirmation.

Before scheduling an appointment with Digestive Disease Care, always confirm that we are in-network with your Medicare plan. If a referral is needed, please request it from your primary care provider in advance. Our team is also available to answer any questions about insurance or referral requirements—just give us a call. We are committed to making your experience as smooth and convenient as possible while helping you take care of your digestive health.

At Digestive Disease Care, we know insurance coverage can feel overwhelming. Here’s a breakdown of how Medicare typically covers these important digestive procedures:

How Medicare Covers Digestive Procedures

• Medicare generally covers colonoscopies and endoscopies when medically necessary.
• Coverage is usually provided under Medicare Part B if the procedure is ordered by your Digestive Disease Care provider.

Colonoscopy Coverage

Screening Colonoscopy:

• Covered by Medicare Part B for colorectal cancer detection.
• If your doctor accepts Medicare assignment, you typically pay nothing out-of-pocket for a routine screening.

If Polyps Are Removed:

• You may be responsible for certain costs (such as coinsurance) if tissue is removed during the procedure.

Endoscopy Coverage

• Covered under Medicare Part B when ordered for symptoms or treatment.
• Medicare pays 80% of approved costs after your deductible.
• You are usually responsible for the remaining 20% coinsurance.

Medicare Advantage (Part C) Plans

• Coverage rules may vary depending on your plan.
• Some plans may have different copays, coinsurance, or network requirements.
• Contact your plan provider or our billing team for exact details.

We’re Here to Help:

• Digestive Disease Care staff can review your Medicare benefits.
• We’ll help you understand coverage and estimate any out-of-pocket costs.
• Contact our office before your procedure with any questions.

At Digestive Disease Care, we provide comprehensive digestive health services, many of which are covered under Medicare.

Medicare-Covered Services:

Office visits and specialist consultations for evaluation of:

• Abdominal pain
• Diarrhea or constipation
• Heartburn or reflux
• Unexplained weight loss
• Gastrointestinal bleeding

• Use of advanced diagnostic tools to manage digestive issues effectively.

Screening & Diagnostic Procedures

Colonoscopy:

• Covered by Medicare for colorectal cancer screening.
• Also covered when medically necessary for diagnostic evaluation (e.g., blood in stool, bowel changes).

Upper Endoscopy (EGD):

• Investigates symptoms like chronic heartburn or difficulty swallowing.
• Helps diagnose ulcers, inflammation, and other upper GI issues.

Other Procedures:

• Liver biopsies
• Removal of polyps
• Additional treatments for digestive tract conditions

Therapeutic Care & Chronic Disease Management:

• Treatment of gastrointestinal bleeding
• Dilation of narrowed digestive tract areas
• Ongoing management of chronic conditions such as:

• Liver disease
• Hepatitis
• Crohn’s disease
• Ulcerative colitis

Medicare may also cover nutritional counseling and follow-up visits as part of ongoing care.

Coordinated, Patient-Centered Care:

• Collaboration with primary care physicians and other specialists.
• Focus on preventive care, patient education, and personalized management plans.

Understanding Your Medicare Coverage:

Coverage depends on:

• Type of Medicare plan (Original Medicare or Medicare Advantage)
• Preventive vs. diagnostic purpose of the procedure
• Meeting clinical criteria for specific services

Our administrative team helps explain benefits and potential out-of-pocket costs.

Out-of-Pocket Costs for Seeing a Gastroenterologist With Medicare

Original Medicare (Part B):

• You pay the annual Part B deductible.
• Medicare covers 80% of approved costs; you pay 20% coinsurance.
• A Medigap plan may cover some or all out-of-pocket costs.

Preventive Procedures (e.g., Screening Colonoscopy):

• Routine screenings are generally covered at no cost.
• If a polyp is removed or biopsy performed, you may owe coinsurance/copayment.

Medicare Advantage (Part C):

• Costs vary by plan.
• Plans may set their own copays, coinsurance, and network rules.

Before Your Visit:

• Check with your plan and confirm with our office.
• Costs depend on your coverage and the services provided.

For more information, please contact us or request an appointment online. We have convenient locations to serve you in Babylon NY, East Setauket NY, Forest Hills NY, Jericho NY, Lake Success NY, Melville NY, Mineola NY, Massapequa NY, New Hyde Park NY and Riverhead NY.