Do I Need a Referral to See a Specialist With Medicare?

Christian Worstell
In this article...
  • Find out if you need a referral to see a specialist with Medicare. We also look at why referrals may be needed and which physicians are considered specialists.

When Do I Need a Referral to See a Specialist With Medicare?

People with complex medical conditions often seek treatment from doctors specializing in the field. Some health insurance plans require you to have a written order from a primary care doctor before they cover the cost of your visit to a specialist. One of the most commonly asked questions by people considering this level of health care is, “Do I need a referral to see a specialist with Medicare?”

Can You Go to a Specialist Without a Referral?

If you're enrolled in the federal government's Original Medicare program, you don't need a referral to see a specialist. Original Medicare typically allows you to see any doctor you wish, as long as they accept Medicare as payment. 

However, you may need a referral to see a specialist with Medicare Part C plans. If you receive health care coverage through a private insurer, confirm the terms of your policy before seeing a specialist.

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Why Referrals Are Required by Some Medicare Insurance Plans

A referral is a written order from a primary care doctor recommending that you obtain the health care services of a specialist. Insurance providers usually ask for a referral before agreeing to pay for services. This helps ensure:

  • You're seeing an appropriate specialist for your condition
  • The services of the specialist can be of benefit to you

You don’t need a primary care physician to refer you to a specialist if you have Original Medicare, giving you the flexibility to coordinate your own care as you see fit.

Which Medicare Advantage Plans Require Referrals?

You may need a referral to see a specialist with Medicare Part C plans. There are different types of Medicare Advantage plans, each delivering health care services in a unique way.  

The following Medicare Part C plans typically require you to have a primary care doctor refer you to a specialist:

  • Health Maintenance Organization
  • Special Needs Plans 

The following Medicare Part C plans usually allow you to see a specialist without a referral:

  • Private Fee-For-Service
  • Preferred Provider Organization

HMOs are generally the only type of Medicare plans that will require a referral.

Which Doctors Are Considered Specialists?

A specialist is a physician with expertise in a specific area of medicine. Specialists usually have several years of advanced clinical training, in addition to general medical training. They may be certified by a governing board in their specialty and are required to keep their skills and knowledge current.

Specialists diagnose, manage and treat certain diseases, conditions, organs or body systems. Here are examples of different specialists:

  • Allergist
  • Cardiologist
  • Dermatologist
  • Endocrinologist
  • Geriatrician
  • Neurologist
  • Obstetrician
  • Oncologist
  • Oral surgeon
  • Orthopedist
  • Pediatrician
  • Podiatrist
  • Psychologist
  • Rheumatologist
  • Urologist
  • Vascular surgeon

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at

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