Medicare Choice Group

Healthcare Provider Networks

The “network” of a Medicare Advantage plan is the group of doctors, hospitals, and healthcare providers that accept the plan. One way to minimize healthcare costs is to stay within your plan’s network as the amount you will have to pay increases when you receive healthcare services out-of-network. Here are the answers to some important questions regarding provider networks.

How are HMO and PPO plans different when it comes to networks?

HMO plans require you to stay within your plan’s network except when emergency or urgent care is needed. If you receive care outside the network for any healthcare services, you will typically have to pay more out of pocket.

PPO plans often have wider networks and allow you to receive services out-of-network, but you will have to pay higher copay/coinsurance costs. Most PPO plans also have an out-of-network deductible you will have to meet before your plan will cover any out-of-network providers.

For more information about HMO and PPO plans, check out this article.

What if there is an emergency?

If there is an emergency or urgent care is needed, your plan is required to cover costs as if the provider is within your network, regardless of whether they are in the United States. Once the situation is no longer an emergency or urgent, you will need to receive follow-up care from a provider within your plan’s network.

How do I know if my doctor is in my network?

Check your insurance company’s website to confirm whether or not your doctor accepts your plan. You will be able to search your provider’s directory online or request a printed copy by contacting customer service. The online version will be more up to date than the printed version.

Are there networks for Medicare Supplement plans?

Most Medicare Supplement plans do not have provider networks since they are secondary coverage to Original Medicare. Therefore, Medicare Supplement plans will cover costs from any provider who accepts Medicare. An exception is when you are on a “select” Supplement plan that uses a hospital for non-emergency coverage.

For help with in- and out-of-network costs and verifying your healthcare provider is within your plan’s network, contact a licensed Medicare agent here.

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