AD Banker Comprehensive Practice Exam

What type of Medicare policy typically requires referrals for specialist care?

1. Medicare Part A

2. Medicare Part B

3. Medicare Advantage Plan

4. Medicare Supplement Plan

The correct answer is: Medicare Advantage Plan

The option that refers to a type of Medicare policy that typically requires referrals for specialist care is a Medicare Advantage Plan. Medicare Advantage Plans operate as private health insurance plans that provide Medicare benefits. They often incorporate managed care features, which usually include referral requirements for seeing specialists. This system is designed to manage costs and ensure coordinated care. In a Medicare Advantage Plan, the enrollee usually must go through their primary care doctor to obtain a referral before consulting with a specialist. This is a common practice in health maintenance organizations (HMOs) and many preferred provider organizations (PPOs), which are types of Medicare Advantage Plans. In contrast, other options, such as Medicare Part A and Part B, do not have this requirement. Medicare Part A provides hospital insurance, while Part B covers outpatient services, both of which do not necessitate referrals. Medicare Supplement Plans, also known as Medigap, are designed to cover costs not fully paid by original Medicare and do not impose any referral requirements.