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Coverage for out-of-network services

For Medica Advantage Solution® (PPO) and Medica Advantage℠ (PPO) Members

As a plan member, you can choose to receive care from out-of-network providers. Your 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 accumulate toward 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 Member Services number on the back of your ID card for more information — including details on out-of-network service cost-sharing. You can learn more in your plan's Evidence of Coverage or Summary of Benefits documents.

View member plan documents

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8 a.m. – 9 p.m. CT, daily

Iowa and Nebraska

8 a.m. – 9 p.m. CT, daily

North Dakota and South Dakota

8 a.m. – 9 p.m. CT, daily

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.

Last updated: December 2023