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No
Generally, if you’re eligible for Original Medicare (Part A and Part B), you can’t be denied enrollment into a Medicare Advantage plan. An exception would be if you have end-stage renal disease (ESRD), which is kidney failure requiring dialysis or a kidney transplant. If you have ESRD, you might not be eligible for Medicare Advantage plans except for certain Special Needs Plans.
If a Medicare Advantage plan gave you prior approval for a medical service, it can’t deny you coverage later due to lack of medical necessity.
Your Medicare Advantage plan isn’t allowed to make statements such as “It is our policy to deny coverage for this service” without providing justification.
If you require care that’s considered medically necessary, and your Medicare Advantage plan doesn’t have providers in its network that provide that care, the plan can’t deny you coverage. The plan has to arrange your care from a qualified out-of-network provider.
If a Medicare Advantage plan gave you prior approval for a medical service, it can’t deny you coverage later due to lack of medical necessity.
Your Medicare Advantage plan isn’t allowed to make statements such as “It is our policy to deny coverage for this service” without providing justification.
If you require care that’s considered medically necessary, and your Medicare Advantage plan doesn’t have providers in its network that provide that care, the plan can’t deny you coverage. The plan has to arrange your care from a qualified out-of-network provider.