What if my clients need “non-urgent care” while they are traveling outside of the area served by their Medicare HMO?
A. Most HMOs do not provide any coverage for non-urgent care received outside of the HMO’s geographic service area. However, a few HMOs will cover non-urgent care outside the HMO’s service area if the care is delivered by pre-approved service providers. If enrollees expect to need health coverage while they travel, they should ask their HMO whether or not it has agreements with other HMOs that would help cover their non-urgent, non-emergency care where they will be traveling. PPOs do offer limited coverage for non-urgent care received outside of their service area. Referrals are not required for out-of-network care, although in some cases, there may be pre-certification requirements. Q. Will a Medicare HMO pay for follow-up care to emergency treatment by a doctor outside its network? A. Medicare managed care plans must pay for any follow-up care required for an emergency condition, whether the enrollees are admitted to a hospital or go for doctor visits after the emergency. Enrollees m
