Fair Square Medicare Wordmark

Do All Hospitals Accept Medicare Advantage Plans?

Visiting a hospital front desk illustrated stock image

By Daniel Petkevich

Apr 11, 2023

Your plan may limit your access to a particular network

Over the last few years, Medicare Advantage plans have witnessed a surge in popularity, with nearly half of all

Medicare

beneficiaries opting for these plans.

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

Medicare Advantage plans offer additional coverage beyond what Original Medicare provides and have an out-of-pocket limit, which can be attractive for individuals on a fixed budget. However, the question that often arises when considering Medicare Advantage plans is whether all hospitals accept them.

Let's take a closer look at Medicare Advantage plans, including their costs and whether all hospitals accept them.

What Are Medicare Advantage Plans?

A

Medicare Advantage Plan

, also known as Medicare Part C or MA Plan, is an alternative option to Original Medicare (Part A and Part B). These plans are offered by Medicare-approved private insurance companies and must adhere to Medicare regulations.

They cover all services under Original Medicare and may also provide additional coverage for services like

vision

, hearing,

dental

, prescription drug coverage (Medicare Part D) and more.

While

Medicare Advantage Plans

may limit your options to a network of healthcare providers, they do offer the benefit of an annual out-of-pocket maximum for Medicare-covered services. This means you'll have a yearly cap on your Medicare expenses even if you require extensive medical treatment.

How Do Medicare Advantage Plans Work?

When you enroll in a Medicare Advantage Plan, the company offering the plan receives a fixed monthly payment from Medicare for your coverage. These companies must abide by Medicare's regulations, but each plan may have different out-of-pocket expenses and rules for accessing services.

For example, you may need a referral to see a specialist or be limited to doctors or hospitals within the plan's network (excluding emergency and urgent care situations).

It's important to stay informed, considering these rules may change annually. Fortunately, it's a prerequisite that each plan provides advance notice of any changes to all members before the next enrollment period.

What Are MAPD Plans?

MAPD, or Medicare Advantage Prescription Drug Plan, is a Medicare Advantage Plan that includes coverage for prescription drugs. In addition to the standard Medicare benefits and prescription drugs, MAPD plans may also offer additional benefits such as vision, hearing, and dental coverage.

While some MAPD plans may limit coverage to in-network services, others may also cover out-of-network healthcare services. However, using providers outside your plan's network may increase out-of-pocket expenses or result in a lack of coverage, depending on your plan details.

What Are the Types of Medicare Advantage Plans?

There are five main types of Medicare Advantage plans, but not every plan is available in your area. You may find all, some, or none of these plans available depending on where you live. You may also find multiple plans of the same type if private companies in your area decide to provide them.

Let's look into the different types of Medicare Advantage Plans**.**

1. Health Maintenance Organization (HMO) Plans

An HMO plan generally only provides coverage if you get medical care from doctors, hospitals, and other healthcare providers within your plan's network. There are exceptions, such as emergency care, out-of-area urgent care, or out-of-area dialysis. You'll always be covered for emergency and urgent care.

Some HMO plans may have a Point-of-Service (POS) option that allows you to receive certain out-of-network services, but this usually comes at a higher cost.

It's worth noting that most HMO plans require you to have a referral from your

primary care doctor

if you need to see a specialist.

2. Preferred Provider Organization (PPO) Plans

PPO plans

offer more flexibility than HMO plans. You can receive healthcare services from providers outside the network, but they are often more expensive.

Note again that you'll always be covered for emergency and urgent care.

3. Private Fee‑for‑Service (PFFS) Plans

PFFS plans have two types: one with a network and the other without.

In PFFS plans that don't have a network, you can typically go to any Medicare-approved doctor, hospital, or healthcare provider who accepts the plan's payment terms and agrees to treat you.

However, in PFFS plans that do have a network, you can typically see any provider within the network who has agreed to treat you. You may also be able to receive care from an out-of-network provider who accepts the plan's terms, but it may cost more.

Either way, you'll always be covered for emergency and urgent care.

4. Medicare Special Needs Plans (SNP)

Special Needs Plans (SNPs) are specifically designed to help Medicare beneficiaries who meet unique criteria. There are three types of SNP plans: Chronic Condition (C-SNP), Institutional (I-SNP), and Dual Eligible (D-SNP). These plans customize their benefits, provider choices, and list of covered drugs (formularies) to best serve their target group's specific needs.

For instance, an SNP may provide additional coverage for extra hospital days if you have a chronic or severe health condition like cancer or heart failure.

While some SNPs may require you to choose a primary doctor within the network, they typically have specialists available to treat the specific conditions of their members.

5. Medical Savings Account (MSA) Plans

Medicare MSA Plans offer an alternative to traditional Medicare coverage. They combine a high-deductible health plan with a medical savings account. The Medicare MSA Plan deposits money into this account, which you can use to pay for your healthcare expenses.

The amount of money deposited into the account will vary depending on your plan. One of the benefits of the MSA is that you can use this money to pay for your Medicare-covered costs before you meet your deductible.

How Much Do Medicare Advantage Plans Cost?

Medicare Advantage Plan premiums are dependent on the specific plan you choose. While some Medicare Advantage plans may offer a zero premium, it's important to note that you will still be responsible for paying the Medicare Part B premium ($164.90 in 2023).

The deductibles, copays, and coinsurance will also vary from plan to plan.

Fortunately, many Medicare Advantage plans come with an out-of-pocket limit. Once you reach this limit for the year, your plan will cover 100% of the approved healthcare services for the remainder of the year.

However, MAPD plans have no out-of-pocket limit on outpatient prescription drugs. This means there is no hard cap on your outpatient drug expenses. But,

Catastrophic coverage

can help reduce your out-of-pocket spending once you enter that stage.

Furthermore, Medicare beneficiaries enrolled in a Medicare Advantage Plan do not need to pay the Part A and Part B deductibles separately. Instead, they must pay their Medicare Advantage plan's deductible (if any).

For example, in case of hospitalization, individuals with a Medicare Advantage plan are not required to pay the Part A deductible or copays. Instead, they pay their plan's deductible (in case it has not been fulfilled yet) along with their daily copays for hospital care. The deductibles and copays differ according to the plan.

Do All Hospitals Accept Medicare Advantage Plans?

While most hospitals do accept Original Medicare, there may be some that do not accept Medicare Advantage Plans.

However, if you have a medical emergency while you're enrolled in a Medicare Advantage plan, you can seek care at any ER or hospital in the country. Your Medicare Advantage plan will cover the emergency services as if they were in-network, even if the hospital or provider is out-of-network. But a copay and coinsurance may be involved in each visit and service obtained.

On the other hand, if you receive non-emergency care from an out-of-network provider, your Medicare Advantage plan may not cover the full cost of care, and you may be responsible for paying a more significant portion of the bill.

Mayo Clinic recently notified its eligible Medicare beneficiaries in Arizona and Florida that it's no longer in-network with most Medicare Advantage plans. Furthermore, they have stated that they will not be able to schedule appointments for patients with Medicare Advantage plans that are out-of-network.

It's advisable to seek medical care from healthcare providers within your network to minimize the risk of unexpected costs. Also, contact your hospital before scheduling in-patient stays to confirm if they accept your Medicare Advantage insurance.

Maximize Your Savings by Staying Within the Network

Private insurance companies approved by Medicare offer Medicare Advantage Plans. These plans cover all services under Original Medicare and may also provide additional coverage for services like vision, hearing, dental, prescription drug coverage, and more.

However, not all hospitals accept all Medicare Advantage Plans. In addition, to get full coverage for your healthcare services, you may need to limit your options to a network of healthcare providers. Some plans allow for out-of-network coverage, but this can be expensive.

If you're in a Medicare Advantage Plan, staying within your network is advisable to get maximum benefits from your health insurance. But if your preferred healthcare provider has moved out of your network, or you're not satisfied with your current plan, you can

change your plan

during the

Annual

Enrollment Period.

On the other hand, if you're planning to join a Medicare Advantage plan, select a plan with a network that includes desired healthcare providers in your area.Analyzing all the aspects of a plan and selecting the best one for you can be overwhelming. Our advisors are well-versed in the minutiae of the plans and can help you make the right choice.

Over the years, we've assisted several Medicare beneficiaries in choosing the right plan. If you need help selecting a plan, call us at 1-888-376-2028, and one of

our advisors

will be happy to guide you through the process.

Speak with a Medicare Advocate

Talk to one of our Licensed Medicare Agents today to find the right plans for you.

Recommended Articles

Medicare cost stock image

How Much Does Medicare Cost?

Jul 25, 2022

woman in a therapist office stock photo

Does Medicare Cover Hypnotherapy?

Nov 22, 2022

Leg bones and knees, 3d rendering. stock photo

Does Medicare Cover Fosamax?

Nov 30, 2022

scleral lenses

Does Medicare Cover Scleral Lenses?

Dec 5, 2022

Cover image

Fair Square Bulletin: We're Revolutionizing Medicare

Apr 27, 2023

Sleep apena stock image

Does Medicare Cover Inspire for Sleep Apnea?

Dec 27, 2022

various cartoon scenarios showing long term care stock photo

Which Medigap Policies Provide Coverage for Long-Term Care?

Sep 16, 2022

Cover image

10 Top Medicare Supplement (Medigap) Companies for 2025

Jul 14, 2025

senior couple doing yoga stock image

13 Best Ways for Seniors to Stay Active in Columbus

Mar 8, 2023

Dripping medication stock photo

Does Medicare Cover Ketamine Infusion for Depression?

Nov 23, 2022

A person with a shopping cart already containing medicaid and medicare sees Medigap options on a table. In a thought bubble, they ask "Should I get Medigap too?"

Do You Need Medigap if You're Eligible for Both Medicare and Medicaid?

Jan 7, 2023

Orthopaedist at work treating a bunion, stock photo

Does Medicare Pay for Bunion Surgery?

Nov 29, 2022

Cover image

2024 Cost of Living Adjustment

Nov 13, 2023

Indianapolis skyline at night stock image

13 Best Ways for Seniors to Stay Active in Indianapolis

Mar 9, 2023

senior man with his glasses in his hand working in front of his laptop stock photo

Can I Change Medicare Advantage Plans Any Time? | Medicare Plans

Sep 19, 2022

Medicare at 62 stock image

Does Retiring at Age 62 Make Me Eligible for Medicare?

Jun 16, 2022

Rattlesnake biting on a hiker's boot stock image

Does Medicare Pay for Antivenom?

Dec 6, 2022

Sinusitis. stock illustration

Is Balloon Sinuplasty Covered by Medicare?

Dec 1, 2022

More of our articles

13 Best Ways for Seniors to Stay Active in Phoenix

Can I Choose Marketplace Coverage Instead of Medicare?

Can I switch From Medicare Advantage to Medigap?

Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?

Can Medicare Help with the Cost of Tyrvaya?

Costco Pharmacy Partners with Fair Square

Denied Coverage? What to Do When Your Carrier Says No

Do I Need Medicare If My Spouse Has Insurance?

Do You Need Books on Medicare?

Does Medicare Cover Abortion Services?

Does Medicare Cover Air Purifiers?

Does Medicare Cover an FMT?

Does Medicare Cover Cardiac Ablation?

Does Medicare Cover Cartiva Implants?

Does Medicare Cover Cosmetic Surgery?

Does Medicare Cover ESRD Treatments?

Does Medicare Cover Flu Shots?

Does Medicare cover Hyoscyamine?

Does Medicare Cover Ilumya?

Does Medicare Cover Inqovi?

Does Medicare Cover Light Therapy for Psoriasis?

Does Medicare Cover Linx Surgery?

Does Medicare Cover Lipoma Removal?

Does Medicare Cover Medical Marijuana?

Does Medicare Cover Nuedexta?

Does Medicare Cover Ozempic?

Does Medicare Cover Penile Implant Surgery?

Does Medicare Cover Physicals & Blood Work?

Does Medicare Cover Shock Wave Therapy for Plantar Fasciitis?

Does Medicare Cover SI Joint Fusion?

Does Medicare Cover SIBO Testing?

Does Medicare Cover Xiafaxan?

Does Medicare Cover Zilretta?

Does Medicare Pay for Funeral Expenses?

Does Medicare pay for Opdivo?

Does Medicare Pay for Varicose Vein Treatment?

Does Medicare Require a Referral for Audiology Exams?

Does Your Medicare Plan Cover B12 Shots?

Estimating Prescription Drug Costs

Everything About Your Medicare Card + Medicare Number

Fair Square Client Newsletter: AEP Edition

How Do I Sign up for Medicare? A Simple How-To Guide For You

How Does Medicare Cover Colonoscopies?

How Much Does Open Heart Surgery Cost with Medicare?

How to Become a Medicare Agent

How to Enroll in Social Security

Is Displacement Affecting Your Medicare Coverage?

Is Gainswave Covered by Medicare?

Is HIFU Covered by Medicare?

Is PAE Covered by Medicare?

Is the Shingles Vaccine Covered by Medicare?

Is Vitrectomy Surgery Covered by Medicare?

Medicare Advantage MSA Plans

Medicare Consulting Services

Medicare Guaranteed Issue Rights by State

Medigap vs. Medicare Advantage

Saving Money with Alternative Pharmacies & Discount Programs

Seeing the Value in Fair Square

The Fair Square Bulletin: October 2023

Welcome to Fair Square's First Newsletter

What Are Medicare Part B Excess Charges?

What Does Medicare Cover for Stroke Patients?

What If I Don't Like My Plan?

What Is a Medicare Supplement SELECT Plan?

What is Plan J?

What is the 8-Minute Rule on Medicare?

What Is the Medicare Birthday Rule in Nevada?

What to Do When Your Doctor Doesn't Take Medicare

What You Need to Know About Creditable Coverage

When Can You Change Medicare Supplement Plans?

Why You Should Keep Your Medigap Plan

Will Medicare Cover it?

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.

Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.

About

Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2025

Terms of Use
Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2025 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M

Fair Square Medicare

FSM symbol - 50