Which of the following is a characteristic of Medicare Advantage Plans?

• A. They provide a limited choice of doctors.
• B. They require referrals to see specialists.
• C. They allow members to see any doctor that accepts Medicare.
• D. They do not cover prescription drugs.

Answer: (C)

The characteristic that Medicare Advantage Plans have is that they often provide a limited choice of doctors compared to Original Medicare. This is due to the fact that Medicare Advantage Plans typically operate through a network of providers. Enrollees are usually required to choose from doctors within this network for their care to be covered, unless they choose to pay out-of-network costs.

Additionally, many plans require members to obtain referrals before visiting specialists, which is a common practice in managed care tiers of Medicare Advantage.

While most Medicare Advantage Plans include prescription drug coverage, there are some that do not. However, the statement about members being able to see any doctor that accepts Medicare is typically more true of Original Medicare rather than Medicare Advantage Plans, which is more restrictive in terms of provider choice.

Thus, the understanding of how Medicare Advantage Plans function should clearly include the aspects of provider limitations and the referral requirement.