What is a referral?

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When one medical provider formally sends a patient to see another medical provider for further evaluation or treatment, this is called a referral. It’s common for primary care providers (PCPs) to refer their patients to specialists (for example, an orthopedist, oncologist, or cardiologist) so that they can obtain a diagnosis or receive care for a particular medical condition.

Many health plans require their members to get a referral from a PCP before the plan will cover specialty care.

Does Medicare require referrals?

Original Medicare (Parts A and B) does not require referrals. You can see any medical provider, including specialists, as long as they accept Medicare, and you don’t need to get a referral to do so.¹

However, many Medicare Advantage plans do require referrals before a member can see a medical specialist. This includes Medicare Advantage HMOs (health maintenance organizations) and POS (point of service) plans.

If you have a PPO Medicare Advantage plan, you will not likely need a referral to see a doctor other than your primary care doctor. But if your Medicare Advantage plan is an HMO or a POS, you’ll likely need a referral.

If your Medicare Advantage plan requires referrals, you’ll need to first schedule a visit with your PCP before visiting a specialist, so that you can obtain the necessary referral.

Will all doctors accept my Medicare coverage?

Q: Will my doctors accept my Medicare card? A: Q: Will all doctors accept my Medicare coverage? A: The answer depends on what type of Medicare coverage you have, and whether you’re already a current patient.

primary care provider

Your primary care provider (PCP) is the medical provider (usually a physician, physician's assistant, or nurse practitioner) who can assess a wide range of medical conditions, coordinate care with specialists, and be your first point of contact when a new medical condition arises.

referral