What You Need to Know About Provider Networks

Medicare Advantage plans utilize “networks” of providers to give you medical care. In order to receive the lowest possible cost for your medical care, it’s important to stay inside of your plan’s network whenever possible. Below we will answer a few important questions about provider networks.

What is the difference in networks for HMO vs. PPO plans?

HMOs (health maintenance organizations) are a type of Medicare Advantage plan that require you to stay inside of the plan’s network except in the case of emergencies and urgent care. PPO (preferred provider organizations) plans allow for wider networks and freedom to go outside of your plan’s network at a higher cost.

Most Medicare PPO plans require you to meet an out-of-network deductible before they will cover out-of-network providers. We always advise staying inside of your plan’s provider network whenever possible to help keep your costs low.

What About Emergency Coverage?

All Medicare Advantage plans are required to cover emergencies and urgent care anywhere in the United States as though it is in-network. Once the emergency situation is resolved and the doctor who is treating you says that you can be safely transported, your insurance carrier will expect you to obtain any necessary follow-up treatment within your plan’s network.

How do I know if my doctor is in my plan’s network?

The best way to confirm if a doctor accepts your plan is to reference your insurance company’s website. All plans allow you to search their provider directories online. You may also request a printed provider directory by contacting your plan’s customer service department. We recommend searching online whenever possible. Printed directories do not reflect new updates to the network and providers may join or drop out of networks at any time.

What if I am on a Medicare Supplement?

Medicare Supplements (also known as Medigap plans) do not usually require you to use provider networks. These plans use Original Medicare as the primary insurance, which means you may see any provider in the United States who accepts Original Medicare. One exception to this is if you are on a “select” Supplement, which utilizes a hospital network for non-emergency coverage.

Questions?

If you would like help verifying if your doctors are in your plan’s network, reach out to us at 877.222.1942 or client@retiremed.com.

If you are not a RetireMed client and have questions about Medicare, please contact us at 937.915.3563 or advice@retiremed.com to get started.

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