A Medicare Advantage provider network is the group of doctors, hospitals, and other medical providers that have agreed to work with a plan. The plan type determines whether you must use that network and what happens if you go outside it.

HMO Networks

In a Medicare Advantage HMO, you generally must use in-network providers for non-emergency care. You may need to choose a primary care doctor and get referrals for specialists.

Exceptions generally include emergency care, out-of-area urgent care, and temporary out-of-area dialysis. An HMO with a point-of-service option may cover some out-of-network services at a higher cost.

PPO Networks

A Medicare Advantage PPO lets you use in-network or out-of-network providers for covered care, but out-of-network services usually cost more. You generally do not need a referral to see a specialist.

An out-of-network provider may still decline to treat you except in an emergency. Check with both the plan and provider before receiving care.

Other Plan Types

Private Fee-for-Service plans may have networks, but a provider must accept the plan's payment terms for the visit. Special Needs Plans serve people with certain health conditions or eligibility needs. Their networks may follow HMO or PPO rules. With a Medicare Medical Savings Account (MSA) plan, you can seek care from a Medicare-approved provider willing to treat you. MSA plans do not include Part D; you need to decide separately how to get drug coverage.

Medicare provides a detailed comparison of Medicare Advantage plan types.

Can Networks Change?

Yes. Providers can enter or leave a network, and plan contracts can change. A printed or online directory is a starting point, not a guarantee.

Before enrolling or scheduling care:

  • Search the plan's current directory
  • Call the plan
  • Confirm with the individual provider and location
  • Ask whether associated facilities are also in-network
  • Save confirmation details

If a provider leaves the network during treatment, contact the plan promptly. In some situations, the plan may let you keep seeing that provider for a time while you arrange care with someone in the network.

If a directory lists the right clinician at a different address, ask the plan to verify the office you will actually visit. For a departure during treatment, see how to request help continuing care.

Networks and Prescription Drugs

The medical provider network and the pharmacy network are separate. Plans with drug coverage also use pharmacy networks; confirming your doctor’s network does not confirm your pharmacy’s status. You may pay less at a preferred pharmacy than at a standard pharmacy in the same network. Out-of-network prescriptions may not be covered except in limited circumstances.

Medicare policy sources last checked: October 8, 2026.