Quote:
Originally Posted by golfing eagles
I guess the big question that people, including myself, would like to know is whether the UHC MA plan $4400(option 1) or $1900(option 2) maximum annual out of pocket expense still applies if the costs were incurred as a result of an approved out of network referral. (I assume if you just go without approval, you're on your own)
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The Medicare site says that an Advantage plan has to cover any procedure that traditional Medicare does.
"Medicare Advantage Plans must cover all of the services that Original Medicare covers. ...."
That's pretty unequivocal. If MA didn't work that way it seems like they would really be pretty iffy.
It also says
"The plan can choose not to cover the costs of services that aren't medically necessary under Medicare. If you're not sure whether a service is covered, check with your provider before you get the service."
The kinda' implies that UHC must pay for medically necessary services.
But the people who manage web site content are typically not the ones who write rules. But it seems like full Original Medicare coverage is what was intended for MA...
Medicare Advantage Plans cover all Medicare services | Medicare.gov