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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. |
Choosing a Network with the Providers You Want
For many people, the most important factor in choosing their insurance plan is which providers they can see.
You probably have at least one doctor you’re comfortable with and know your medical history. Maybe at some point they saved your life, or helped you through some major healthcare decisions. Our team can help you research the networks in each plan to determine which accept some or all of your doctors. If we cannot find a plan that you are satisfied with and has all of your providers, our team can help you find new providers and switch over to them.
Value-Based or Preferred Networks
In the last decade or so, value-based or preferred networks have become increasingly popular.
Value-based providers are compensated based on the quality of care they provide, not the quantity. The results are positive for the insured, provider and insurance company. Insurance carriers in particular support value-based care because it lowers costs while improving patient outcomes.
Our team at Connie Health can help you find choose value-based providers who can provide better healthcare outcomes and lower your overall costs.
Learn more about Medicare
Turning 65: Medicare and You
Learn about how to approach Medicare decisions as you turn 65.
A Guide to Medicare Networks
Learn more about the differences between networks.
