Moab and southeast Utah · Doctor visits for 2027
What Does a Moab Specialist Visit Cost on Medicare in 2027?
On the 12 general Advantage plans sold in Grand County, an in-network specialist visit costs $25 to $70 for 2027. The price matters less than two rules beside it: which plans need a referral, and which ones pay anything when the specialist is out of network.
The short answer
- Original Medicare: usually 20% of the Medicare-approved amount after the Part B deductible, at any specialist who takes Medicare, in either state.
- Medicare Advantage in Grand County, 2027: $25 to $70 per in-network specialist visit; eight of the 12 plans sit between $40 and $60.
- Referral: required on the four UnitedHealthcare HMO-POS plans, not on the eight PPOs.
- Out of network: 30% or 50% of the cost on the PPOs; not covered on the HMO-POS plans, outside emergencies and urgent care.
The standard answer
Under Original Medicare, Part B covers specialist visits the same way it covers any doctor. Medicare.gov puts the cost at "usually 20% of the Medicare-approved amount" after the Part B deductible, and there's no network: any specialist who accepts Medicare works, whether the office is in Moab, Grand Junction or Salt Lake City. A Medigap plan can pay that 20%.
A Medicare Advantage plan swaps the 20% for a flat copay and adds a network. In Moab that second part is the one that bites, because many specialty appointments mean a drive to Grand Junction or the Wasatch Front.
Specialist copays on every general Grand County plan
Each plan's specialist line comes from CMS's 2027 plan benefit file. I checked the UnitedHealthcare numbers against the carrier's own 2027 Grand County plan pages, which list the same in-network copays (UT-0008 shown here).
| Plan | Specialist visit (in network) | Referral needed? | Out-of-network specialist | Monthly premium |
|---|---|---|---|---|
| AARP Medicare Advantage from UHC UT-0003 (HMO-POS) H4604-003 | $25 | Yes | Not covered | $49 |
| AARP Medicare Advantage Essentials from UHC UT-4 (HMO-POS) H4604-011 | $25 | Yes | Not covered | $0 |
| Humana Essentials Plus Giveback (PPO) H5216-430 | $40 | No | 50% | $0 |
| Humana USAA Honor Giveback (PPO, no drug coverage) H5216-455 | $40 | No | 50% | $0 |
| HumanaChoice H5216-048 (PPO) H5216-048 | $45 | No | 50% | $97 |
| HumanaChoice H7617-016 (PPO) H7617-016 | $45 | No | 50% | $110 |
| Humana USAA Honor Giveback (PPO, no drug coverage) H7617-021 | $45 | No | 30% | $0 |
| Humana USAA Honor Giveback (PPO, no drug coverage) H5216-427 | $50 | No | 30% | $0 |
| AARP Medicare Advantage Extras UT-7 (HMO-POS) H4604-018 | $55 | Yes | Not covered | $0 |
| AARP Medicare Advantage from UHC UT-0008 (PPO) H2001-128 | $60 | No | 30% | $0 |
| AARP Medicare Advantage Patriot No Rx UT-MA01 (HMO-POS) H4604-005 | $65 | Yes | Not covered | $0 |
| AARP Medicare Advantage Giveback from UHC UT-9 (PPO) H2001-131 | $70 | No | 30% | $0 |
Sources: CMS 2027 benefit file, section 7d (physician specialist) plus the out-of-network and point-of-service tables; UnitedHealthcare 2027 plan pages for ZIP 84532; premiums from the CMS CY2027 landscape. "Not covered" excludes emergencies and urgent care, which every plan must cover. You still pay your Part B premium. Listing a plan is reporting, not a recommendation, and we do not offer every plan available in your area.
The cheapest specialist copays in the county, $25, are on two HMO-POS plans that also require a referral and pay nothing for an out-of-network specialist. The PPOs charge more per visit, but they'll pay something if your specialist isn't in their network.
The Grand Junction question
For a lot of Grand County households, "specialist" means a cardiologist, an orthopedist or an oncologist in Grand Junction, about two hours away and across the Colorado line. How that visit is billed comes down to one fact: is that specific doctor in your plan's 2027 network?
- If yes: you pay the in-network copay from the table, on any of the 12 plans. The state line doesn't matter.
- If no, on a PPO: the plan pays, and you pay 30% or 50% of the cost instead of a flat copay. On a $300 visit that's $90 or $150.
- If no, on an HMO-POS: the four UnitedHealthcare HMO-POS plans in Grand County use their point-of-service benefit for dental only, so a routine out-of-network specialist visit isn't covered. Medicare.gov lists the exceptions: emergencies, urgent care while you're out of the service area, and temporary dialysis.
Look up each doctor by name in the plan's 2027 directory, or call the specialist's office and give them the exact plan name. "We take UnitedHealthcare" or "we take Humana" isn't the same as being in that plan's network. I wrote more about crossing the state line for care in our Moab travel coverage post, and about getting there in whether Medicare pays for rides to the doctor.
Have specialists in Grand Junction or Salt Lake?
Bring their names. We'll check them against the Grand County plans we offer, along with your prescriptions, and show what each visit would cost. Free, at our Moab office or by phone.
Book a call →Referrals: one more step on four plans
On the UnitedHealthcare HMO-POS plans (UT-0003, UT-4, UT-7 and Patriot No Rx UT-MA01), your primary care doctor has to send a referral before a specialist visit counts. In a small town that's usually a phone call, but the referral has to be on file before the appointment, or the plan can refuse the claim. The two UnitedHealthcare PPOs and all six Humana PPOs let you book a specialist directly.
Several UnitedHealthcare plans also list a $0 copay for a virtual visit with a network telehealth provider. For a follow-up that doesn't need an exam, that can save a four-hour round trip. Our telehealth post covers what Medicare allows from home through 2027.
How the copays add up
Someone managing a heart condition might see a cardiologist four times a year. At $25 a visit that's $100; at $70 it's $280. Both count toward the plan's yearly in-network cap, which on these plans runs from $4,900 to $9,150 for 2027. For most people, the network and referral rules matter more than the $45 gap between the cheapest and priciest copay.
With Original Medicare and a Medigap plan such as Plan G, the same four visits cost nothing beyond the once-a-year Part B deductible, at any specialist in either state who takes Medicare. Plan N may charge up to $20 for some office visits. You pay for that freedom with the monthly Medigap premium.
Monticello and Blanding
San Juan County has 11 general plans for 2027: the same six Humana PPOs, with the same copays and out-of-network coinsurance, and five UnitedHealthcare HMO-POS plans. There are no UnitedHealthcare PPOs there. The five HMO-POS plans all require a referral and don't cover routine out-of-network specialists. They charge $25 (UT-0003, UT-4), $45 (UT-0005), $55 (UT-7) or $65 (UT-MA01). If your specialists are in Cortez, Durango or Grand Junction, the network check above matters even more.
How we know all this: the Medicare On Main Data Desk frames every article with public data. Here that means CMS's 2027 plan benefit and landscape files, UnitedHealthcare's 2027 plan pages for Grand and San Juan counties, and Medicare.gov's doctor services and HMO pages, all read November 6, 2026. Benefits can differ in a plan's final documents, so confirm them in its Summary of Benefits and Evidence of Coverage. Carrier names are factual reporting, not endorsement. This is education, not advice. Compare plans with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan.
Frequently asked questions
How much is a specialist copay with Medicare Advantage?
It depends on the plan. In Grand County, Utah, for 2027, the 12 general Medicare Advantage plans charge $25 to $70 for an in-network specialist visit. Most fall between $40 and $60. Several UnitedHealthcare plans also list $0 for a virtual visit with a network telehealth provider.
Do I need a referral to see a specialist on Medicare Advantage?
On an HMO, usually yes. In Grand County the four UnitedHealthcare HMO-POS plans require a referral for specialist visits in 2027. The two UnitedHealthcare PPOs and the six Humana PPOs don't. Medicare.gov notes that in most HMOs you need a referral to see a specialist.
Can I see a specialist in Grand Junction on a Utah Medicare Advantage plan?
Yes, if the specialist is in your plan's network, the in-network copay applies even across the state line. If they're out of network, the eight PPO plans in Grand County pay with 30% or 50% coinsurance, and the four HMO-POS plans don't cover the visit except in an emergency or for urgent care. Check the doctor by name in the plan's 2027 directory.
What does a specialist visit cost with Original Medicare?
Medicare.gov says you usually pay 20% of the Medicare-approved amount after the Part B deductible, at any doctor that accepts Medicare, in any state. With a Medigap plan such as Plan G, that 20% is covered. Plan N may charge up to $20 for some office visits.
Does the specialist copay count toward the out-of-pocket maximum?
Yes. In-network specialist copays count toward the plan's yearly cap, which runs from $4,900 to $9,150 on the general Grand County plans for 2027. On a PPO, out-of-network costs count toward a separate, higher combined limit. UnitedHealthcare lists $10,750 combined on its UT-0008 plan.
Sources
- CMS — 2027 Plan Benefit Package benefits file (ZIP)
- CMS — CY2027 Medicare Advantage and Part D landscape files (September 2026, ZIP)
- UnitedHealthcare — AARP Medicare Advantage from UHC UT-0008 (PPO), 2027 plan details for Grand County
- Medicare.gov — Health Maintenance Organization (HMO) plans
- Medicare.gov — Doctor and other health care provider services
