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 24 licensed agents
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 Melonie Wood on April 12, 2025
Agent Licensed in FL & AL
Answered by Mark Maliwauki on May 23, 2025
Broker Licensed in ID, AZ, CA & 15 other states
Some HMO plans have a Point of Service (POS) option, which might allow you to go out of network for certain services, but at a higher cost. Your best bet is to contact your plan provider to confirm whether any exceptions apply to your specific plan.
Answered by Nikki Rowland on May 7, 2025
Broker Licensed in SC & NC
Answered by Ben Washington on May 1, 2025
Broker Licensed in IL, FL, MN, SC, TX & WI
However, some plans may have specific exceptions or allow for out-of-network referrals under certain circumstances. It's best to check your specific plan details or contact your insurance provider directly to understand your options and any potential costs involved.
Answered by Michael Ryan on May 14, 2025
Broker Licensed in CA, AZ, CO & 7 other states
Answered by Timothy Brown on April 13, 2025
Broker Licensed in PA, CT, DE & 15 other states
I highly recommend sticking with in-network doctors to keep your medical expenses lower. HMO plans typically do not cover any costs for out-of-network doctors. If you wish to see doctors outside the plan's network, a PPO would be the way to go.
Answered by Diana Garner on April 24, 2025
Broker Licensed in KY, FL, IN, OH & TN
Answered by Leslie Helene Sussman on March 31, 2025
Broker Licensed in NJ, FL & PA
Answered by Dana Dane on April 3, 2025
Agent Licensed in OR, AZ, CA & 6 other states
Answered by Shelly Hefley on March 29, 2025
Broker Licensed in IN, AL, IL, KY & TN
Answered by James Stang on May 17, 2025
Agent Licensed in OH
Answered by Peter Joseph on April 7, 2025
Broker Licensed in CA, AL, AR & 39 other states
Answered by Fred Manas on May 14, 2025
Agent Licensed in NY, CT, DC & 7 other states
Answered by Gary Henderson on April 14, 2025
Agent Licensed in TX, AK, AL & 46 other states
That choice is between and the doctor you want to see
Answered by Marcie Barnes on May 22, 2025
Agent Licensed in TX, AK, AL & 48 other states
Answered by Donnie Vermillion on May 12, 2025
Broker Licensed in TX
You would need your HMO to be a true POS (Point Of Service) HMO that allows you to see out-of-network providers and still have some coverage.
Or, if your HMO doesn't happen to have a cardiologist in the network, then you might be able to get an exception to see an out-of-network one and be covered. This would take a prior approval/authorization from the HMO company.
Or, if your PCP recommends/refers a cardiologist that is out-of-network, and they are willing to go to bat for you and get the insurance company to get that cardiologist approved.
I hope that helps.
Regards,
Chris (The Medicare Analyst)
Answered by Chris Prang on April 28, 2025
Broker Licensed in VA, AZ, CA & 13 other states
Answered by Scott Klag on April 21, 2025
Agent Licensed in OH
Answered by Nicolas Johnson on May 28, 2025
Agent Licensed in WI & IA
Answered by Alaina Hunt on June 2, 2025
Agent Licensed in KS & MO
Answered by Carl-Daniel Cole on May 21, 2025
Broker Licensed in MO, AL, AR & 23 other states
2. Some HMO plans may allow "out-of-network" services. But most do not.
Answered by Vernon Pate on June 2, 2025
Broker Licensed in AR, MO & OK
Answered by Barbara Hawes on May 19, 2025
Broker Licensed in NJ, AZ, CT & 18 other states
Tags: Medicare Advantage
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