Rick Thomas
What to do know about UHC HMO Referral System
Understanding Medicare Referrals in 2026
What’s Changing and What You Need to Know
Medicare rules change all the time, and 2026 is bringing one update that has caused a lot of questions — referrals on Medicare Advantage HMO plans.
If you’re on a UnitedHealthcare Medicare Advantage plan, or considering one, you may hear more about referrals next year. That word alone can sound intimidating, but the reality is much simpler than it seems.
The short version:
This change is about care coordination, not about limiting your access to care — and it’s not something you need to stress about.
What’s changing in 2026?
Starting in 2026, many Medicare Advantage HMO and HMO-POS plans will once again require referrals for certain specialist visits. This brings these plans back in line with how a traditional HMO was designed to work.
Your primary care doctor becomes the central point of your care, helping coordinate who you see and why. That ensures your doctors are working together instead of in separate silos.
There is also a built-in grace period early in the year while medical offices adjust to the process, with full enforcement beginning later in the spring.
What this does not mean
This does not mean:
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You need referrals for everything
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You can’t see specialists
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You’ll be stuck with medical bills if something is missed
Emergency room care, urgent care, mental health services, OB-GYN visits, preventive care, labs, imaging, and many therapy services do not require referrals.
And if a referral is ever missed, you cannot be balance billed for it.
Who is responsible for referrals?
This is an important point:
The referral process is primarily a provider responsibility, not a patient responsibility.
Doctors’ offices handle submitting referrals electronically. This change impacts how healthcare offices coordinate care behind the scenes — not what you are expected to manage day to day.
If you ever want peace of mind before a specialist visit, it’s reasonable to ask the specialist’s office if the referral has been received. But this is not something you’re expected to chase or manage.
Why we made this video
We created the short video below to walk through:
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What a referral actually is
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Why this change is happening
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When the rules start and when they’re enforced
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What happens if a referral isn’t done
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What you should (and shouldn’t) worry about
Most importantly, we wanted to explain this in plain language — without scare tactics or insurance jargon.
Watch the video below
If you have questions after watching, or if something doesn’t sound right in your specific situation, reach out. That’s what we’re here for.
Thank you for trusting Thomas Family Insurance to help guide you through Medicare changes — not just at enrollment, but along the way.
God Bless!
Rick Thomas
Thomas Family Insurance