By Mary Ashkar, Senior Attorney, Center for Medicare Advocacy
Prior to becoming eligible for Medicare, many Americans who have health insurance through employment are enrolled in some type of managed care plan. Health Maintenance Organizations (HMOs) are one of the most common types of managed care plans. Generally, individuals enrolled in HMOs are restricted to networks of providers, and must see certain health care providers to get coverage for their medical care. In addition, individuals in HMOs must obtain a referral from their primary care physician before obtaining treatment from a specialist such as an oncologist, a rheumatologist or a psychiatrist.
This lack of freedom and choice disappears when someone becomes eligible for Medicare and chooses the traditional Medicare program. Unlike Medicare Advantage, which offers Medicare’s private plan options, traditional Medicare includes open access to most health care providers throughout the country. In Medicare Advantage, as in most HMOs, if you require non-emergency or non-urgent services while you are out-of-network, you will likely have to pay 100% for those services. Traditional Medicare, on the other hand, travels with you.
With traditional Medicare you can go to any doctor or hospital in the United States that accepts Medicare, so you have more choice and don’t have to worry about being out-of-network. This is particularly important for “snowbirds,” people who spend a large amount of time traveling away from their homes, and people who want to be cared for by particular providers or hospitals, or near relatives in different parts of the country. In addition, in traditional Medicare you don’t need a referral to see a specialist so you avoid this potential roadblock if you need a specialist for necessary health care.
Older and disabled Americans in traditional Medicare do not have to worry about networks of providers, the costs associated with going out-of-network, or getting referrals for the specialized health care they need. Instead, they can take their accumulated wisdom and experience and focus on doing something awesome. So – for those of you who are eligible, welcome to Medicare! Whatever your purpose in life, you now have more freedom, flexibility and choice with traditional Medicare.