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Medicare Provider Networks in Arizona
A question which frequently gets asked about Medicare is: “What doctors and facilities will I be able to use?”
This is a big deal for people at or approaching Medicare age. The reason is simple. You probably have providers you have known for years. You are comfortable with them, you trust them and they are convenient for you.
Now, though, you may be changing to Medicare from a medical insurance plan you’ve had for years, or maybe your whole career. And depending on which Medicare coverage plan you choose, there may be restrictions on which providers are available to you.
To select the right Medicare plan for you, it’s important to understand the differences between different networks depending on how you decide to purchasing your Medicare coverage.
Original Medicare (plus Medicare Supplement or Medigap plan)
With Original Medicare (and Medicare Supplement or Medigap plan) you can see any provider which accepts Medicare assignment. Be aware some providers may not accept Medicare assignment. As an example, only 58% of providers in Maricopa county currently accept new Medicare patients.
You aren’t required to get a referral form your primary physician in order to see a specialist.
You can be treated at any hospital or facility that accepts Medicare assignment. At present the Mayo Clinic in Maricopa County is the only hospital which doesn’t accept Medicare assignment for new patients.
Only Medicare-approved services (parts A & B) are eligible to be covered.
Medicare Advantage PPO (Preferred Provider Organization)
If you belong to a Medicare Advantage PPO, you can see both in-network and out-of-network providers without needing a referral from your Primary Care Provider to see a specialist. Usually you will pay more for out-of-network providers.
Some Medicare Advantage PPO plans do not include all hospitals and medical facilities. Check the list of providers for each plan for details.
Medicare Advantage PPO plans may include routine dental, vision and hearing services.
Medicare Advantage HMO (Health Maintenance Organization)
In a Medicare Advantage HMO, you can only use in-network providers.
In most cases a referral from your primary care physician is required to see a specialist.
You are also required to use network hospitals and medical facilities. Some plans in Networks do not include all hospitals
Medicare Advantage HMO plans may also include routine dental, vision and hearing services. You may be limited to in-network providers.
Key Differences Between Medicare Plan Options
| HMO | PPO | Supplement | |
|---|---|---|---|
| Provider Network |
Must use network providers. |
Can see providers in and out of network. Out of network typically at higher cost. |
Can see any provider that accepts Medicare assignment. |
| Referrals |
Most require referrals to a specialist. |
Does not require referral. |
Does not require referral. |
| Medical Facilities & Hospitals | Must use network hospitals and medical facilities. Some plans in Arizona do not include all hospitals. | Can see providers in and out of network. Out of network typically at higher cost. Some plans in Arizona do not include all hospitals. | Can receive treatment at any facility or hospital that accepts Medicare assignment. Mayo Clinic is the only Arizona hospital not accepting new Medicare patients. |
