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A person enrolled in an SNP must choose a primary care doctor and will need a referral to access specialist care. ... People with Original Medicare do not need a referral to see a specialist ...
They also do not have to choose a primary doctor and may not need a referral to see a specialist. In general, prescription drug coverage is not included in original Medicare, although a person may ...
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.
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.
The member(s) are not required to use a gatekeeper or obtain a referral before seeing a specialist. In that case, the traditional benefits are applicable. If the member uses a gatekeeper, the HMO benefits are applied. However, the beneficiary cost sharing (e.g., co-payment or coinsurance) may be higher for specialist care. [3]
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