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  2. When do you need a Medicare referral? - AOL

    www.aol.com/lifestyle/medicare-referral...

    A person may need a referral from a primary care doctor to access some of the services that Medicare covers. Various parts of Medicare have different rules about referrals.

  3. How to compare Medicare Advantage plans - AOL

    www.aol.com/compare-medicare-advantage-plans...

    When comparing Medicare Advantage plans, ... People enrolled in an HMO need a referral from their doctor to visit a specialist. PPO. A person may want to consider the following factors about PPO ...

  4. Stark Law - Wikipedia

    en.wikipedia.org/wiki/Stark_Law

    Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity for the provision of designated health services ("DHS") if the physician (or an immediate family member) has a financial relationship with that entity.

  5. Do most doctors accept Medicare? - AOL

    www.aol.com/lifestyle/most-doctors-accept...

    Each Medicare Advantage plan has different rules for how a person may receive services, such as whether a person needs a referral to see a specialist and whether they need to see an in-network doctor.

  6. Physician self-referral - Wikipedia

    en.wikipedia.org/wiki/Physician_self-referral

    There is a large volume research indicating that self-referral has a major effect on increasing medical costs in the US. David Levin estimated the cost of unnecessary self-referred imaging in 2004 to be, conservatively, $16 billion per year. [3] There are several examples showing that self-referral increases utilization and costs:

  7. Managed care - Wikipedia

    en.wikipedia.org/wiki/Managed_care

    For example, if patients stay in a network of providers and seeks a referral to use a specialist, they may have a copayment only. However, if they use an out of network provider but do not seek a referral, they will pay more. POS plans are becoming more popular because they offer more flexibility and freedom of choice than standard HMOs.

  8. The pros and cons of Medicare Advantage plans - AOL

    www.aol.com/finance/pros-cons-medicare-advantage...

    Medicare Advantage plans have annual out-of-pocket limits for Part A and Part B services; Original Medicare does not: In 2025, the Medicare Advantage cap is $9,350 for in-network services and ...

  9. Centers for Medicare & Medicaid Services - Wikipedia

    en.wikipedia.org/wiki/Centers_for_Medicare...

    The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.

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