What is an open access plan?

A CarePlus open access plan is a type of Medicare Advantage plan that allows our members to see in-network specialists within their plan’s service area without having to get a referral from their primary care physician (PCP). 

Even if you don’t need a referral from your PCP, it’s still important to keep them in the loop. Your PCP coordinates all the care you receive from other in-network specialists, hospitals, skilled nursing facilities or home healthcare agencies. It’s important for your PCP to be aware of any other provider you see to maintain a complete record of your health.

Please note that even though you won’t need a referral to see an in-network  specialist on this type of plan, the specialist may still need prior authorization from your health plan before administering certain types of care. Prior authorization is a step that helps ensure medical necessity of certain services before your health plan covers them.

Should I still see my PCP?

Yes. Even though our CareAccess (HMO) open access plan does not require you to see your PCP for referrals, you should still see them for your annual wellness visit, basic health diagnosis and treatment and other check-ups.

Regularly seeing your PCP can help you achieve your best possible overall health.

Who is a good fit for this plan?

If you regularly see certain specialists for needed care and want to avoid having to get a referral before every visit, this type of plan may be convenient for you.