Travel Limitations Direct access by the patient to Medicare certified providers across the country. Plans may require disenrollment for extensive travel. Emergency - Urgent Care Coverage Access is at the discretion of the patient. Patients have guidelines to follow to determine whether care is urgent or emergent and generally need a referral or must notify plan or PCP within a limited time of treatment. Co-pays for emergency room treatment often apply, but may be waived upon admission to the hospital.
Some plans allow providers to bill patients for services plan determines to be non-emergent.
Certain medical conditions may cause a plan to refuse coverage or may cause your premiums to increase substantially. Ease of changing plans Certain medical conditions may cause a plan to refuse coverage or may cause your premiums to increase substantially. If you previously had a Medigap policy and dropped it for a Medicare HMO, you may not be able to repurchase gap insurance, especially from the carrier you dropped. Often a physician has worked carefully to find the right medication for a patient's condition. In certain HMOs, that particular brand of drug may not be listed on the formulary causing the patient to pay out of pocket, or switch to a medication that has been less than effective for them in the past.