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Medicare Advantage: HMO Special Rules

Urgently Needed Care

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Medicare defines Urgently Needed Care as an unexpected illness or injury that needs immediate medical attention, but is not life threatening.

Urgently Needed Care is only covered when provided by non-network providers if you are temporarily outside the HMO service area. If you are in the HMO's service area, you must receive Urgently Needed Care from a network provider in order for it to be covered.

Examples of Urgently Needed Care:

  • Food poisoning causing diarrhea and/or vomiting.
  • Replacing needed medication that was lost with your luggage.
  • Flu or other illness severe enough to require medical attention.
  •  Blisters or other foot problems that impair your ability to walk comfortably.

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