doctor referral

Do I Need Referrals With Medicare?

Medicare is a type of health insurance that’s meant primarily for seniors in retirement. It typically takes the place of insurance provided through an employer and covers many medically necessary costs. If you’re new to Medicare, then it’s important that you understand the different types of policies available and what sets them apart from each other.

The Two Types of Medicare Policies

There are two main types of policies included within Medicare. These two types are Original Medicare and Medicare Advantage. One of the primary differences between them is the degree of flexibility that they allow. Original Medicare has very standardized coverage and does not allow the beneficiary to make any modifications to their policy. On the other hand, Medicare Advantage does allow additional areas to be added, such as vision and hearing coverage.

Which type of policy you choose will depend on your personal medical situation and the type of coverage you want to have in the future. Another big differentiator between the two policies is whether or not they require beneficiaries to get a referral when they need to see specialists.

Original Medicare

When it comes to Original Medicare, beneficiaries do not need to get a referral when they need to see a specialist. However, the specialist must accept Medicare. This is a rule that should always be followed, in order to make sure that you have as much coverage as possible and won’t have to pay the full amount out-of-pocket.

Medicare Advantage

Medicare Advantage includes multiple policies. Whether or not Medicare Advantage policies require referrals depends on the specific policy.

PPOs and HMOs are the two most common options within Medicare Advantage. The difference between them is whether or not beneficiaries have coverage if they seek care out-of-network. PPOs typically do not require referrals, while HMOs usually do.

Which Type of Policy is Right For You?

At Turning 65 Solutions, we understand how important it is that you have the coverage you absolutely need and deserve. That’s why we will help you compare all your coverage options with Original Medicare and Medicare Advantage.

Regardless of your policy choice, we’re here to provide you with guidance. Making the right decisions can be challenging, especially when there are so many choices within Medicare. If you’re feeling confused or overwhelmed, make an appointment to speak with someone at Turning 65 Solutions, we’re here for whatever insurance questions you have.

Turning 65 Solutions can help you plan for the future.