Many Medicare Advantage (MA) Plans (like HMOs or PPOs) have networks of health care providers which include doctors, other health care providers, hospitals, and facilities. It’s important to understand your plan’s provider network to make sure you get the care you need at the lowest cost
To learn more about your MA Plan’s network, consider asking your plan these questions:
- How can I ﬁnd out if my providers are in the plan’s network?
- How much do I pay for services in-network?
- How much do I pay for services out-of-network?
- What if I need covered treatments that aren’t available from a provider in the plan’s network?
- What happens if my provider stops participating in the network?
- Who can I call with questions and concerns?
Things to remember
- You can contact your MA PLAN to request a provider directory, or you can ﬁnd it on you plan’s website.
- If there’s a particular hospital or health care provider you want to use, you may need to ask your primary care doctor for a referral.
- Your MA PLAN can add or remove providers from its network at anytime during the year. If your provider is no longer in the network, you’ll need to choose a new provider in the network to get covered services.
- Always check your provider when you schedule an appointment to conﬁ rm they’re still in you plan’s network
Each year, during the Medicare Open Enrollment Period (October 15-December 7), you can review the provider networks for the plans you’re considering.
Centers for Medicaid & Medicare –October 2017
Please contact: Jane Reese-Wilkins & Associates for your no cost obligation Plan Review 626 372 9097 janereesewilkins@ yahoo.com.
Our new address is: 1199 N. Lake Ave Pasadena CA 91104.