Which statement is correct about out-of-network services in an HMO MA Plan?

In an HMO (Health Maintenance Organization) Medicare Advantage (MA) Plan, the typical structure encourages members to use a network of providers for their healthcare needs, which generally means that out-of-network services may not be covered or may come with significant cost-sharing. However, in situations involving emergencies or urgent care, members are permitted to seek out-of-network services.

This allowance is crucial because emergencies may occur unexpectedly and may require immediate attention, potentially at a facility outside the established network. For urgent care, which typically arises from situations that are not life-threatening but still require prompt medical intervention, members also have the option to access out-of-network services. This access acknowledges the reality that emergencies do not adhere to provider networks and that timely care is essential for health outcomes.

Thus, the option indicating that emergency visits and urgent care can be accessed out-of-network is correct, as it aligns with the general flexibility provided in HMO MA Plans for critical situations, ensuring that members can receive necessary care when they need it most.