Medicare Insurance Networks can be very confusing, especially if you have a Part C Advantage Plan. You need to know which network you are on and how to use it. We will explain three of the most common networks: the PPO (Preferred Provider Organization), the HMO (Health Maintenance Organization), and the Medicare Network overall. If you are in an HMO or PPO plan these plans replace your original Medicare Parts A and Part B. With these plans’s benefits and costs and have networks. This post only discusses the networks, not the benefits of the different types of Medicare Insurance Plans. We will look at each type of network in this post.

HMO (Health Maintenance Organization). This type of Medicare Advantage Plan has only In-Network medical providers with specific rules. Normally the HMO plan will have a lower maximum out-of-pocket cost with more additional benefits.

• You must have a PCP (Primary Care Physician).
• To get a referral to a specialist you must have your PCP make the referral, you cannot self-refer.
• Your PCP will determine which network of providers you are in.
• PCPs can be changed each month.
• If you go out of your HMO network for services, you will be responsible for the entire cost.
• To receive urgent care or emergency services in your area you should use the in-network providers.
• The network is normally geographically local which does not allow you to go to providers in other states or counties.

PPO (Preferred Provider Network). This type of Medicare Advantage Plan allows you to go out-of-network for medical providers and has specific rules. Normally the PPO plan will have higher costs and fewer additional benefits.

• You do not need to have a PCP.
• To see specialists, you can self-refer.
• When you use an in-network provider you will pay less.
• When using out-of-network providers you must ask the provider if they will accept the terms of your plan.
• The network could be geographically local or national.

Original Medicare Part A and Part B. If you use your Medicare card for medical services, you should have a Medicare Supplement Plan and a Part D drug plan to help cover your costs.

• Your network is any Medicare provider that accepts Medicare.
• You do not need a PCP (Primary Care Physician).
• You can self-refer to any Medicare provider in the United States.
• When receiving services you should present both your Medicare Card and your Medicare Supplement card if you have one.

Conclusion:

It is best to understand the Medicare Insurance Plan you have and how to use it, as well as where to go for information about the plan. It can be very costly to go outside the rules of your plan to receive treatment. Many people believe they only need to ask if the doctor or provider takes Medicare when in fact, they are on a Medicare Advantage Plan.

If you live near Huntington Beach California and would like a local Medicare Agent with experience, please visit Welch Insurance for Medicare.