How your coverage
treats your doctors.
Original Medicare
With Original Medicare, you can see any doctor or hospital in the U.S. that accepts Medicare. A Medicare Supplement (Medigap) policy, if you have one, works alongside it. Medicare SELECT policies are the exception: they can require network hospitals, and sometimes network doctors, for full benefits.
Medicare Advantage HMO
HMO plans generally require you to use doctors and hospitals in the plan’s network, except for emergency care, out-of-area urgent care, and temporary out-of-area dialysis. You usually choose a primary care doctor, and many plans require referrals to see specialists.
Medicare Advantage PPO
PPO plans let you see providers outside the network, usually at a higher cost. Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. Call the plan’s customer service number or see its Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
In California, ask about the medical group.
Many Medicare Advantage HMOs in California work through contracted medical groups or independent physician associations (IPAs). Your primary care doctor’s medical group must contract with the plan, and specialist referrals often stay within that group. When you enroll, you may choose or be assigned a medical group.
That means a doctor can be in one plan’s network through one medical group and not in another. When you call the office, ask which medical group the doctor belongs to, and whether that group works with the plan you’re considering for 2027.
Learn more from Medicare.gov: compare Original Medicare and Medicare Advantage.