What may happen if a member chooses out-of-network providers for preventive care?

Choosing out-of-network providers for preventive care can lead to the member bearing all costs. In Medicare Advantage plans, network providers are contracted to provide services at reduced rates, and these plans often have specific networks to control expenses and ensure quality of care. If a member opts for out-of-network services, especially for preventive care, it’s likely that the plan does not cover these services or will cover them to a limited extent. This often leaves the member responsible for the full price, which can be significantly higher than what they would pay in-network.

It's important for members to understand their plan’s network restrictions and the financial implications of going out-of-network. While some plans may allow out-of-network services in certain circumstances, preventive care is typically best utilized within the network to ensure coverage.