How Medicare Advantage plans can help you see a specialist without a referral

Medicare Benefits

Sep 8, 2021

Many Medicare Advantage (MA) plans require you to visit your primary care physician (PCP) for a referral before seeing a specialist. If you’ve had to see specialists and have been frustrated by the process of getting your visits approved, you may consider switching to a different MA plan that will let you see a specialist without a referral.

When can you switch Medicare Advantage plans?

You may be able to switch to a Medicare Advantage plan that doesn’t require you to see your primary care physician for a referral during one of the following enrollment periods:

• Annual Election Period (AEP): From October 15 through December 7, you have the opportunity to make a change to your Medicare coverage. You can switch from one MA plan to another, drop Original Medicare and enroll in a Medicare Advantage plan, switch PDPs (Prescription Drug Plans), or even drop your MA plan and revert to Original Medicare (and enroll in a PDP at that time).
• Medicare Advantage Open Enrollment Period (MA-OEP): From January 1 through March 31, you may make one change to your coverage. For instance, you may switch from your current MA plan to another one that will allow you to see a specialist without a referral.
• Special Enrollment Period (SEP): You may be eligible to make a change to your Medicare plan outside of a regular enrollment period if you experience certain life events, including but not limited to moving out of your plan’s service area, moving into a nursing home, or qualifying for Medicaid.

Ready to switch to a plan that doesn’t require a referral to see a specialist?

If you’ve needed to see a specialist with Medicare and have been frustrated by the referral process, consider MA plans that may give you greater flexibility. Compare your current coverage to other plans available in your area. As you explore your options, a knowledgeable, licensed sales agent may be able to help you narrow down your choices and find the plan that meets your needs. And, they may be able to help you enroll when you’re ready. If seeing a specialist without a referral is important to you, find a plan that will meet your needs now and in the future.