Does Medicare Advantage Have In-Network Providers?

Medicare Advantage plans are an “all in one” bundled alternative to Original Medicare. They are also called Medicare Part C or MA Plans, and they are offered by Medicare-approved private insurance companies that must follow Medicare’s rules. With Medicare Advantage plans, you often get more coverage than just Medicare Part A and Part B, such as dental, vision, wellness, and/or prescription drugs.

There are multiple Medicare Advantage plans: Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, Private Fee-for-Service (PFFS) plans, Special Needs plans (SNPs), and Medicare Medical Savings Account (MSA) plans.

How Do Medicare Advantage Networks Work?

Every Medicare Advantage plan can charge different costs and have different rules for how you get services, such as if your plan uses a network, or if you need to choose a primary care doctor and get referrals to see specialists.

Some types of plans are more reliant on networks than others. In HMO plans, you generally have to get your services from in-network providers, except emergency care, out-of-area urgent care, and out-of-area dialysis. If your doctor leaves the plan, your plan will notify you and you can choose another in-network doctor. If you decide to get services outside of the plan’s network, you may be required to pay the full cost. 

PPO plans use network doctors, hospitals, and other health care providers but are a little more flexible than HMO plans. If you use in-network doctors, hospitals, and other health care providers, you pay less. If you use out-of-network doctors, hospitals, and other health care providers, you pay more. Because certain providers (in-network) are “preferred,” you save money when you use them.

To learn more about which Medicare Advantage plans expect you to use in-network or out-of-network providers, reach out to Temmen Insurance today. We specialize in Medicare Advantage and will make sure you get the plan that fits your needs the most.

Can I Use Out-Of-Network Providers with Medicare Advantage?

Yes, you can use out-of-network providers with Medicare Advantage, but it will almost always cost more. Depending on your plan, you may be required to pay the full cost of services. If you have a more flexible network, you may pay more but not the full cost of services. 

Get the Coverage You Need

Temmen Insurance can help you get there! We are specialists in simplifying the Medicare process and making coverage suggestions that fit your unique needs and lifestyle. Reach out today for a free quote and let’s get you the coverage you need with the providers you love.

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