Wouldn’t that be true for any PPO or network HMO plan (not necessarily Medicare Advantage ones), since each plan has its own list of in-network providers?
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I just had an initial meeting with the insurance broker. There are basically 3 major MA plans available, and she said all the hospitals and most of the major medical providers accept all 3. Except the group I currently see! That is the public hospital system in Denver, and they only accept (fully) Aetna. I think I might try that till the end of the year and then if I don’t like it I can switch.
One of the other plans is a little better, in her opinion, because it doesn’t require referrals for specialists, and you can go to anyone up and down the front range.
All have no premium. All have the same drug benefits except may classify drugs differently into different tiers (so you might pay a $10 co-pay with one and a $47 co-pay with another).
My friend went with Part G and a non-MA plan because she feels her drugs are too expensive under MA.
Medicare Advantage is a managed care plan. Even if they call it a PPO instead of a HMO they still have in-network and out-of-network providers. If you’re a light user of medical care and die in your sleep in old age with little medical care needed prior to that time then Medicare Advantage is probably a big win. However if you get sick and need hospital care, need to see specialists, want to see someone at a teaching hospital, then with Medicare Advantage you may pay a lot in order to do so since there may be significant co-pays or they may be out-of-network.
Again this is not true for BC/BS in MA. We need to be careful about generalizing either way. I have many serious conditions including a diagnosis of cancer, and have had no problems. Clearly Massachusetts is a good state for these plans. I like the low annual cap on out of pocked expenses. MY monthly premium is $79. It covers dental, vision and hearing and I am cared for by at-home physicians as needed.
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I’m glad to hear they have an extensive network in MA. However the point remains; if a hospital is not in network, and out here in CA there are regular brinkmanship battles, then you’re on the hook.
Blue Cross in MA says this
Depending on your plan, you may pay more if you use providers that are not in our network. Out-of-network/non-contracted providers are under no obligation to treat Medicare PPO Blue SaverRx (PPO), Medicare PPO Blue ValueRx (PPO), and Medicare PPO Blue PlusRx (PPO) members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service
https://home.bluecrossma.com/collateral/sites/g/files/csphws1571/files/acquiadam-assets/55-0605_2023_Med_PPOBlue_SOB.pdf
Mass General says this for BC/CS
Accepted - Medicare Advantage for specialty/referral care only, no primary care.
https://www.massgeneralbrigham.org/content/dam/mgb-global/en/patient-care/patient-and-visitor-information/billing/insurance/pdfs/MGH-Insurance-Accepted.pdf
That’s strange. My PCP is in the MGH system, and also I don’t need referrals at all, for any of my appointments anywhere, with my PPO BC/BS plan. Thanks for the info. Clearly it is accurate since it comes from the source, but I am going to have to look into it more.