Doctors and networks · 2027
Many people in Ontario, Upland, Rancho Cucamonga, Chino and Pomona get care from Kaiser Permanente, San Antonio Regional Hospital, Pomona Valley Hospital Medical Center, Loma Linda University Health, Chino Valley Medical Center or Montclair Hospital Medical Center. Most Medicare Advantage plans, including HMOs and PPOs, use provider networks, and networks can change between plan years and during the year. Here is how to check before you choose 2027 coverage.
Serene Insurance Solutions is not affiliated with or endorsed by the health systems named on this page. Their names are used only to help you identify where you receive care.
Original Medicare
You can see any doctor or hospital in the U.S. that accepts Medicare. No referrals or medical group needed. A Medigap policy, if you have one, works alongside it. Medicare SELECT policies are the exception: they can require network hospitals, and sometimes network doctors, for full benefits.
Medicare Advantage HMO
You generally need to use doctors and hospitals in the plan’s network, except for emergency care, out-of-area urgent care, and temporary out-of-area dialysis. Many HMOs require referrals to see specialists.
Medicare Advantage PPO
You can see providers outside the network, usually at a higher cost. Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. Call the plan’s customer service number or see its Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Many Medicare Advantage HMOs in California work through contracted medical groups, also called IPAs. Your doctor may belong to a medical group, and that group has to contract with the plan. When you join an HMO, you usually choose a medical group and primary care doctor, or one is assigned to you. Your referrals to specialists and hospitals generally go through that group.
So it is not enough to ask whether a hospital or clinic “takes” a plan. Ask whether your specific doctor, through their medical group, will be contracted with the specific plan for 2027.
Kaiser Permanente is both a health system and an insurance company. If you get care at a Kaiser Permanente facility, such as the Ontario Medical Center, ask Kaiser Permanente directly how your 2027 coverage choice affects where you can receive care.
Compare plans at Medicare.gov Plan Finder. Free, non-sales counseling is available from California’s HICAP program or 1-800-MEDICARE.
Networks are set for each plan year, and medical groups and hospitals can join or leave a plan’s network on January 1. Even if you keep the same plan, check that your doctors and medical group are still in network before December 7. Our 2027 enrollment guide covers the dates and a review checklist.
Toby will check your doctors, medical group and prescriptions against each 2027 plan he represents, and explain what he finds in plain language. There is no cost for his help.
Networks are specific to each plan, doctor and medical group, and they can change from year to year and during the year. Medicare also has rules about how agents can advertise plan details. The most reliable answer comes from checking your doctors against specific plans, which we do with you one-on-one.
Accepting Original Medicare does not mean a doctor is in every Medicare Advantage plan’s network. In California, it also matters whether your doctor’s medical group contracts with the plan. Ask about the specific plan you are considering for 2027.
A medical group or IPA is an organization of doctors that contracts with health plans. With many California HMOs, you choose a medical group and primary care doctor when you enroll, or one is assigned to you. Your specialists and referrals usually come through that group.
Yes, networks can change during the year. Plans are generally required to notify affected members. If it happens, call us and we will talk through your options.
You have options, including Original Medicare with a separate drug plan and possibly a Medigap policy. The right choice depends on your doctors, prescriptions, budget and enrollment rights.
Bring your list of doctors, medical groups and prescriptions. Toby will help you understand which 2027 options fit.
Prefer to talk now? Call.
866-660-4141Toby comes to you for in-home appointments, or meets by phone and video across California, Nevada and Arizona.
