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 don't require a referral, like these:
- Yearly screening mammograms
- An in-network pap test and pelvic exam (covered at least every other year)