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Before you see a specialist in your HMO network (except for an
OB-GYN), you must generally get a referral from your primary care
doctor. This requirement is waived for emergency treatment and
out-of-the area urgent care. If your current doctors are not under
contract with the HMO, you must select new physicians who are part
of the California HMO network.
If you want to see a doctor outside the plan (known as an
out-of-network or non-preferred doctor), and you do not have a
pre-approved referral, you cannot use your MA plan card or your
Medicare card to pay for those services. You will need to pay for
some or all of the costs of your care.
Some California HMOs offer a Point-of-Service (POS) option that
allows you to see doctors outside the plan's network, often for an
additional cost. HMOs that offer this option may also limit when you
can use it.
Some HMOs offer Medicare Part D prescription drug coverage and
others do not. If you are in an HMO plan that does not offer Part D
coverage, you generally cannot get other Part D coverage outside of
your plan. See Prescription Drugs for more information.
HMOs are the most popular type of MA plan in California, but they are
not available in every part of the state. California's HMO Guide for
Seniors, produced by the University of California, Berkeley, and the
State of California Office of the Patient Advocate, is a good resource
for learning how managed care plans work. It can also help you
understand your rights to get the most out of your plan.
Preferred Provider Organizations (PPO)
Private Fee-for-Service Plans
Medicare Special Needs Plans
Medical Savings Accounts (MSAs)
Call our toll-free number or fill out the Quick web form to get Medicare
Advantage Plan Information or Question Answered. We can answer
any questions you may have to help you understand the plan
differences and we will gladly assist you through the enrollment
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and qualified staff of Medicare Advisors.
Call our toll-free number or fill out the Quick
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differences and we will assist you through the
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If you enroll in a California Medicare HMO, you will
be required to use only doctors and facilities that
contract with your particular HMO. You will have a
primary care doctor who manages your personal
health care needs.
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