Do Medicare Savings Account (MSA) Plans Have a Network?

Medicare Savings Account (MSA) plans offer a distinct approach to healthcare coverage within the Medicare system. This article clarifies the structure of MSA plans and their approach to provider networks.

Understanding Medicare Savings Account Plans

A Medicare Savings Account (MSA) plan is a type of Medicare Advantage plan that combines a high-deductible health plan (HDHP) with a medical savings account. The high-deductible health plan is a Medicare-approved private insurance policy that covers costs only after a high yearly deductible is met.

Medicare provides a specific amount of money each year, deposited by the plan into the beneficiary’s medical savings account, typically at the beginning of the calendar year. Beneficiaries cannot deposit their own money into this account. The funds in the MSA are used for qualified medical expenses before the plan’s deductible is satisfied. Any money remaining in the account at year-end rolls over and can be used for future healthcare costs.

Provider Network Characteristics of MSA Plans

Medicare Savings Account plans generally do not have provider networks for Medicare-covered services. This means that beneficiaries enrolled in an MSA plan typically have the flexibility to seek care from any doctor, specialist, or hospital that accepts Medicare.

When receiving care, beneficiaries usually pay for services directly from their MSA funds until their high deductible is met. After the deductible is satisfied, the high-deductible health plan will cover 100% of Medicare-covered services for the remainder of the year. Providers cannot charge more than the Medicare-approved amount for services during the deductible phase. Funds in the MSA can also be used for certain qualified medical expenses not covered by Medicare, such as dental, vision, or hearing services.

Contrasting MSA Plans with Other Medicare Options

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), allows beneficiaries to see any doctor or hospital nationwide that accepts Medicare. This provides a similar level of freedom in provider choice as an MSA plan.

In contrast, most Medicare Advantage (Part C) plans, such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), typically operate with defined provider networks. HMO plans generally require beneficiaries to receive care from providers within their network, with limited exceptions for emergencies. PPO plans offer more flexibility, allowing beneficiaries to go outside the network, but usually at a higher cost. Unlike these network-based plans, MSA plans offer a distinct model by largely removing network restrictions for covered services.

Navigating Healthcare Provider Choices with an MSA Plan

Beneficiaries with an MSA plan should confirm that their chosen healthcare provider accepts Medicare. This is a fundamental step, as the plan covers services from any Medicare-approved provider. Since MSA plans typically do not require referrals for specialists, individuals can directly schedule appointments with any specialist who accepts Medicare.

When paying for services, beneficiaries can use funds from their MSA, often through a checking account or a special debit card provided by the bank. It is important to keep detailed records of all healthcare expenses paid from the MSA, as these funds are tax-exempt when used for qualified medical expenses. If the MSA funds are depleted before the deductible is met, beneficiaries are responsible for paying out-of-pocket until the deductible threshold is reached, after which the plan takes over payment for Medicare-covered services.