Do enrollees need a referral to see an out-of-network provider under Medicare Advantage?

Enrollees in a Medicare Advantage plan do not generally need a referral to see an out-of-network provider, but it is crucial for them to verify whether that provider accepts their specific Medicare Advantage plan. This verification is important because coverage for out-of-network services can vary based on the plan type, and some may cover them only at a higher out-of-pocket cost or not at all.

Selecting an out-of-network provider without ensuring their acceptance of the plan could lead to unexpected expenses. This flexibility is particularly significant for enrollees who may wish to seek care from a specialist or provider outside their established network, allowing for broader choices while still enabling them to get necessary medical services with an understanding of potential costs involved.