Medicare Advantage referral requirements have changed

You spoke, we listened

We are pleased to announce that beginning October 15, 2026, through 2027, our Medicare Advantage (MA) members will not be required to get a referral from their primary care provider (PCP) to see an in-network specialist.

After hearing feedback and concerns from our MA members, we believe this change will make it easier for you to get timely access to quality care. Members do not need to do anything – this change is already in place.

Here are answers to some Frequently Asked Questions about this change:

Why are you making this change?

After hearing feedback from our MA members, we have decided to remove the MA referral requirement as part of our ongoing efforts to improve access to care while improving the overall healthcare experience for our MA members.

Do I need to do anything?

No, you do not need to do anything. This change has already happened.

Do I still need to see a PCP?

Yes, you will still be assigned to a PCP, and that provider can help you navigate your healthcare needs. The only change is that you will be able to see an in-network specialist without first getting a referral.

Are any referrals still required?

Yes, referrals are still required for out-of-network care, or as required by individual providers.

What about referrals for Greater Good Health (GGH) plan members?

Members on Greater Good Health plans will still need to see a GGH primary care provider, but they will not need a referral to see an in-network specialist.

What if I have questions?

If you have any questions about this change, please call the Blue Cross of Idaho Customer Service Department at 1-888-494-2583 (TTY:711). We’re available 8 a.m. to 8 p.m., seven days a week, October 1 through March 31, and Monday through Friday, April 1 through September 30.

Y0010_MK26430_C

Written by: Blue Cross of Idaho
Published: October 21, 2026