Hospital and specialist access
- Confirm the hospital, clinic, doctor group, and specialist are in network for the exact plan.
- Ask whether referrals are required from a primary care provider.
- Ask whether a planned out-of-area visit is covered before traveling.
- Verify emergency, urgent care, and post-stabilization rules.
Authorization and discharge risks
- Prior authorization for surgery, imaging, rehab, skilled nursing, home health, and DME
- Length-of-stay reviews and discharge planning rules
- In-network skilled nursing, rehab, and home health agency options
- Appeal rights if coverage is denied, reduced, or stopped
Senior home setup questions
- Which DME suppliers are in network?
- Does the plan require a contracted home health agency?
- Who coordinates hospital bed, walker, wheelchair, oxygen, CPAP, wound care, or diabetes supplies?
- What documents are needed before the senior leaves the hospital?
Questions to ask
Is my preferred hospital in network for this Medicare Advantage plan?
Are my specialists and post-hospital providers in network?
Which services require prior authorization?
What happens if I need rehab, home health, hospice, or DME after discharge?
How do I appeal if care is denied or stopped early?