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HOW THE PLAN WORKS
Your Oxford Medicare Advantage Member ID card is your passport to receiving all of your Oxford Medicare Advantage covered services. In nearly all instances, you will need to present your Oxford Member ID card prior to receiving covered services, so that the provider of those services can verify your coverage. You should carry your Oxford Medicare Advantage Member ID card with you at all times.

Each Oxford Medicare Advantage Member is required to choose a primary care physician (PCP). If you have a medical concern, you should make an appointment with the PCP listed on your Oxford membership card. Female Members may also choose an OB/GYN in addition to their PCP.

Although your PCP (or OB/GYN) can provide a large part of your care, there will be instances when you require treatment from a specialist. If your PCP or OB/GYN determines that you require the care of a specialist, they will refer you to an Oxford participating specialist.

If your PCP or the specialist recommends that you have a medical procedure that requires surgery or hospitalization, it will be necessary for the procedure to be precertified by the Oxford Medical Management Department.

Unless you are enrolled in the Oxford Medicare Advantage PlusSM point-of-service plan, from the effective date forward, all covered services must be received from Oxford Medicare Advantage participating providers, except for emergency services, urgently needed services, out-of-area dialysis services or covered services for which prior authorization has been obtained. If an Oxford Medicare Advantage enrollee receives services from non-participating providers or participating Medicare Providers without prior authorization, except for emergency services, urgently needed services, or out-of-area renal dialysis services, neither Oxford nor Medicare will pay for those services.

To find out more about covered services please refer to the Summary of Benefits for your area.

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