When you select a Medicare Advantage HMO plan, you also need to select the medical group who will guide your services. The primary care physician you select will be the one who will refer you to specialists in the group. Your ancillary services, hospital and skilled nursing services are with providers who are contracted with the medical group you have selected.
Because Medicare pays the Medicare Advantage plans to take care of you, and the Plans pay the medical groups, with most medical groups you need to notify your Plan by the 15th of a month what medical group/primary care physician you want to switch to as of the 1st of the following month. You will need to confirm that you Plan you are selecting is contracted with that medical group and that your new primary care physician accepts that Plan and is accepting new patients.
If the medical group/primary care physician you want does not work with your current Plan, typically you will need to review your options for another Plan during Open Enrollment (10/15-12/7 – change of Plan to be effective January 1st of the next year) focusing on those Plans that the medical group you want to change to will take. Or if there is a 5 Star Medicare Advantage plan in your area, you are allowed 1 change onto that Plan during the year.
Remember, before making any change, make sure you understand what the benefits are under that new Medicare Advantage plan and confirm that your prescription drugs are listed in the formulary and at what tier and what your out-of-pocket costs will be.