I signed up for a Medicare Advantage HMO, and I’m wondering if I can see a cardiologist out of network without paying everything myself.

Answered by 3 licensed agents

This on can be tricky.

Using an HMO plan typically means you would want to stay within the network in order to keep your costs as low as possible. If you see a doctor outside of the network, you could end up paying the full cost for that care. There could be some exceptions if this was an emergent care issue while out of network. Be careful seeing an out of network doctor on an elective basis.

Some HMO plans are Point of Service (POS). A POS plan may allow you go out of network for some things. If it is a POS plan, you can probably count on paying a higher price if you choose an out of network provider, however.

Call your plan provider and double check before having the services provided. It's really the only way to know for certain what you're facing. Wish you best!

Answered by Bill Filer on March 28, 2025

Agent Licensed in MO, GA, KS & TN

Answered by Bill Filer Medicare Insurance Agent
Generally HMO needs to be IN Network providers. Contact your carrier to request an approval for Out of Network Specialist. You must get approval and not always guaranteed.

Answered by Leslie Helene Sussman on March 31, 2025

Broker Licensed in NJ, DE, FL & PA

Answered by Leslie Helene Sussman Medicare Insurance Agent
If you go out of network you would be paying the entire cost. If you would discuss options, please call me - you have a couple of days to make the change. After 4/1/2025 you are stuck on the HMO until 2026

Answered by Shelly Hefley on March 29, 2025

Broker Licensed in IN, AL, IL, KY & TN

Answered by Shelly Hefley Medicare Insurance Agent

Tags: Medicare Advantage

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