How Medicare Advantage Plans Limit Your Network and Access to Specialty Care
While a lower monthly premium can make Medicare Advantage (MA) plans an attractive option over traditional Medicare, these plans can limit your freedom to choose your own doctor, the care you can receive, and your ability to stay close to home for care.
Medicare Advantage plans may look simple and easy on the surface because they include Medicare Part D while also offering a low monthly premium, but these plans have significant limitations on the network of care providers you can have access to.
Network Limits
Unlike traditional Medicare plans that let you see almost any doctor anywhere in the country, MA plans limit your ability to choose your own doctor by restricting your choices to specific in-network doctors.
This means that if your local doctor is no longer in your plan’s network, you may be forced to travel far from home for care you would normally be able to receive in your own community with traditional Medicare.
Network restrictions also affect your freedom to receive care when travelling. Because MA plans limit which doctors and services they cover to the plan’s specific geographic area, you may be unable to see a doctor if you are travelling away from home. Traditional Medicare plans on the other hand allow you to see any doctor virtually anywhere in the country.
Specialist Limits
In addition to limiting the doctors you can choose to those in the MA plan’s network, most MA plans limit your access to specialists in two ways.
First, MA plans require referrals to see a specialist, unlike traditional Medicare plans that do not require a referral for specialists. Even if your doctor refers you to a specialist, that specialist may not be covered by your MA plan because of network limits. This means you could be forced to travel to find an in-network specialist or see a specialist outside of your plan’s network.
Secondly, MA plans require prior authorization for any specialist referrals. This means that even if your doctor has referred you to a specialist for needed care, the MA plan can step in and deny the referral, overriding the decision of your doctor and limiting your ability to receive needed specialty care.
No one knows what the future holds and what specialty care you may need in the future, and MA plans restrict access to specialty care that often becomes a bigger part of our health care needs as we age.
The Risks of Medicare Advantage
MA is not a substitute for traditional Medicare. MA plans are incentivized to minimize their costs by limiting your care access to a limited network of providers.
From limiting your ability to choose your own doctor to denying specialist services recommended by your doctor, MA plans take away your freedom to get the care you need in the community you live in. These plans also introduce more risk into your health care plan, as needed specialist care can be denied.
Don’t risk losing access to specialty care with MA plans that can overrule your doctor’s recommendations. Talk to your doctor about the drawbacks of Medicare Advantage plans and make sure you have all the facts before deciding about your health care coverage.
Learn more about the limits of Medicare Advantage plans here.
