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A person may need a referral from a primary care doctor to access some of the services that Medicare covers. Various parts of Medicare have different rules about referrals.
Each Medicare Advantage plan has different rules for how a person may receive services, such as whether a person needs a referral to see a specialist and whether they need to see an in-network doctor.
Medicare Advantage plans must offer all the same basic coverage Original Medicare does, and many provide other types of benefits, too. ... But you won’t need a referral to see a specialist.
Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.
Key Points. Medicare Advantage can be a cost-effective alternative to original Medicare. Before signing up for an Advantage plan, make sure you understand the costs and restrictions.
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles ...