As a member of our plan, you can choose to receive care from out-of-network providers. Our plan will cover services from either in-network or out-of-network providers, as long as the services are covered benefits and medically necessary.
You may use any provider that accepts Medicare. The amounts you pay for covered services out-of-network accumulates towards a combined maximum out-of-pocket amount for both in-network and out-of-network providers. Once you have reached your combined maximum out-of-pocket amount, you will have 100% coverage and will not have any out-of-pocket costs for the rest of the year for covered Part A and Part B services.
Call the Medica Member Services located on the back of your ID card, or see your plan's Evidence of Coverage or Summary of Benefits documents for more information, including the cost-sharing that applies to out-of-network services.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
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Last Updated: November 2022