Start with the hospital access question
- Does the hospital accept the exact Medicare pathway you use: Original Medicare, Medicare Advantage, retiree coverage, or dual Medicare and Medicaid?
- Are the hospital, doctor group, anesthesiology, imaging, lab, rehab, skilled nursing facility, and pharmacy benefits handled separately?
- Will planned care require a referral, prior authorization, medical-necessity documentation, or network exception?
- If the hospital is out of state, is the care considered planned, urgent, emergency, or part of an approved referral?
Original Medicare access checks
- Ask whether the hospital and clinician accept Medicare assignment.
- Ask how Medigap, if you have it, may affect cost-sharing for the hospital or specialist visit.
- Ask how Part D prescriptions will be handled after discharge or after a specialist visit.
- Ask how follow-up care, imaging, home health, rehab, or skilled nursing will be coordinated near home.
Medicare Advantage access checks
- Verify the exact plan network, not just the insurance company name.
- Ask whether the hospital, specialist, facility, anesthesia group, imaging site, rehab provider, and DME supplier are all in network.
- Ask whether the plan requires referrals or prior authorization for imaging, surgery, second opinions, rehab, or specialty drugs.
- Ask what happens if a national center, cancer center, heart center, or out-of-state specialist is outside the plan service area.
Before scheduling major care
- Request written answers when possible from the plan, hospital billing office, and specialist office.
- Gather Medicare cards, plan cards, medication lists, prior authorization numbers, referral documents, imaging, lab results, and current bills.
- Ask who will handle denials, appeals, records transfer, and follow-up if care involves more than one facility.
- Use this as a navigation checklist, then confirm all coverage and medical decisions directly with official sources and licensed professionals.
Compliance-safe reminder
This page does not recommend a Medicare plan, sell Medicare coverage, or decide which path is best for you. Use it to prepare questions for Medicare.gov, SHIP counselors, insurers, hospitals, clinicians, and properly licensed professionals.