Beginning May 1, 2026, some Medicare Advantage patients may need a referral from their primary care provider before seeing a cardiologist.
UnitedHealthcare, the largest Medicare Advantage provider in the United States, is implementing a new policy for patients enrolled in its HMO and HMO Point of Service plans. Under this policy, patients must first obtain a referral from their primary care provider before scheduling an appointment with a cardiologist.
Although the policy officially began on January 1, 2026, UnitedHealthcare will begin denying claims for specialist visits without a referral starting May 1, 2026. Patients in California, Nevada, and Texas have already been subject to similar referral requirements throughout 2026.
What Services Are Not Affected?
Some services will not require a referral. These include cardiac rehabilitation, physical therapy, dialysis, emergency room and urgent care visits, and medical imaging performed by a radiologist.
Why Is This Change Happening?
UnitedHealthcare has stated that the referral requirement reflects the structure of HMO plans, which focus on primary care led coordination. The company says that stronger involvement from primary care providers can support earlier diagnosis, better management of chronic conditions, and more proactive care. Referrals are effective as soon as they are submitted by the primary care provider.
Some specialists have expressed concern that adding another step to the scheduling process may make it more difficult for elderly patients to access heart care, particularly for those who were previously able to schedule specialist visits directly.
There are also concerns about the additional workload placed on primary care providers at a time when physician shortages and burnout remain ongoing challenges nationwide.
If you are enrolled in a Medicare Advantage plan and have questions about whether this change affects you, we encourage you to contact your insurance provider directly to review your specific plan requirements.
For additional details about the new referral requirements, you can read the full article from Cardiovascular Business here: https://cardiovascularbusiness.com/topics/healthcare-management/healthcare-policy/its-about-get-harder-many-medicare-patients-see-cardiologist
