Skip Navigation

Do I have to get a referral to see a specialist in Medicare Advantage Plans?

Health Maintenance Organization (HMO) Plans

In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don't require a referral.

Preferred Provider Organization (PPO) Plans

In most cases, you don't have to get a referral to see a specialist in PPO Plans. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.

Private Fee-for-Service (PFFS) Plans

You don't have to get a referral to see a specialist in PFFS Plans.   

Special Needs Plans (SNPs)

In most cases, you have to get a referral to see a specialist in SNPs. Certain services, like yearly screening mammograms or an in-network pap test and pelvic exam (covered at least every other year), don't require a referral.