Medicare HMO Education
What Is a Medical Group ID (IPA)?
How physician networks, delegated medical groups, and Independent Practice Associations coordinate your healthcare under Medicare Advantage.
Core Definition
A Medical Group ID (or IPA ID) identifies an organized network of primary care physicians, specialists, and affiliated medical facilities. In Medicare Advantage HMO plans like SCAN, the health plan delegates clinical management and authorization decisions to this local medical group rather than processing them centrally.
Why Medicare HMOs Use Medical Groups
In a standard PPO plan, patients can see any provider without a referral. In an HMO plan like SCAN Health Plan:
- You choose a Primary Care Physician (PCP).
- Your PCP belongs to a designated Medical Group (IPA).
- When you need to see a cardiologist, dermatologist, or orthopedic surgeon, your PCP submits a referral request to that Medical Group.
- The Medical Group verifies network participating providers and approves the referral.
How It Differs from an Insurance Group
• Insurance Group ID:Links employees to a corporate employer benefit contract (absent on individual Medicare plans).
• Medical Group ID:Links patients to a local physician network coordinating clinical care and approvals.