As a Health Partners Medicare member, you must usually receive your care from a network provider.
In most cases, care you receive from an out-of-network provider (a provider who is not part of our plan's network) will not be covered. Here are some exceptions:
- Health Partners Medicare Prime (HMO-POS), Complete (HMO-POS) and Simple (HMO-POS) plans include out-of-network specialist (and certain other service) coverage with 20% coinsurance which does not apply to the annual maximum out-of-pocket
- if you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. You or your doctor must get prior authorization (approval for these services in advance) from Health Partners Medicare. In this situation, you will pay the same as you would pay if you got the care from a network provider.
- The plan covers emergency care or urgently needed care that you get from an out-of-network provider.
- Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan's service area.
- Health Partners Medicare Prime (HMO-POS), Complete (HMO-POS) and Special (HMO SNP) include worldwide emergency care which covers up to $5,000 in annual expenses incurred while outside the United States.
For more information, call Member Relations at 1-866-901-8000 (TTY 1-877-454-8477) or see the Evidence of Coverage for your plan.