It’s about to get harder for many Medicare patients to see a cardiologist
UnitedHealthcare, the largest Medicare Advantage provider in the United States, is implementing a new policy on May 1, 2026, that will require patients to receive a primary care provider (PCP) referral before seeing a cardiologist. This affects all patients enrolled in the insurer’s HMO and HMO-point of service (POS) Medicare Advantage plans.
The policy, which also covers cardiothoracic surgeons, vascular surgeons and several other specialties, officially went into place on Jan. 1. However, UnitedHealthcare announced at the time it would not start denying claims due to a lack of a referral until May 1. Existing referral policies in California, Nevada and Texas mean that PCP referrals have already been required in those states for all of 2026.
There are several exceptions to this new rule, including cardiac rehabilitation, physical therapy, dialysis and various emergency room/urgent care services. Medical imaging provided by a radiologist is another key exception.
“The referral requirement for specialist visits reflects the core design of HMO plans, which emphasize primary care‑led coordination,” a UnitedHealthcare representative told Cardiovascular Business. “Stronger PCP engagement can support earlier diagnosis, better chronic condition management, and more proactive care—ultimately contributing to improved health outcomes.”
The representative also emphasized that these referrals are effective as soon as they are submitted by the PCP.
Industry reactions to the new policy
There is a fear among many specialists that this added step will result in elderly patients missing out on care altogether. Securing an approval can be confusing for some patients, for instance, especially if they previously did not need a PCP referral to see a specific specialist.
There are also concerns about asking PCPs to take on additional work at a time when burnout is already high and physician shortages are already a significant problem throughout the United States.
Amit J. Shanker, MD, chair of the Heart Rhythm Society (HRS) Health Policy Committee and a Heart Rhythm Advocates board member, pointed to this policy is part of an ongoing issue with Medicare Advantage plans.
“There is a growing trend of hospitals and health systems terminating contracts with Medicare Advantage due to persistent prior authorization denials and delayed reimbursement,” he told Cardiovascular Business. “Over the past three years, approximately 90 health systems have severed ties with some or all Medicare Advantage plans. When hospitals drop plans, patients may face restricted physician access or higher out-of-pocket costs. This recent additional provision (effective May 1) by UnitedHealthcare further increases the barrier to cardiology access for patients.”
Meanwhile, Wendell Potter, a former health insurance executive who became a whistleblower and now advocates for policy reform, wrote about this update at length online. He said requiring these PCP referrals could save UnitedHealthcare “millions, if not billions of dollars” by reducing specialist visits. He also noted that the insurance juggernaut has “doubled down” on its efforts to shed high-cost patients in the wake of the 2024 murder of CEO Brian Thompson, a moment some analysts predicted might result in “kinder, gentler” policies.
Click here for additional information about the referral requirements for UnitedHealthcare’s Medicare Advantage HMO and HMO-POS plans.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.