I too can self refer with my Medicare Advantage Plan...and am covered when traveling within the USA. I have an "HMO/POS" type of Advantage plan. And for some services, like PT, copay is the same whether in network or out of network. I pay less than a Medigap plan for premium each month, but I did not choose the least expensive Advantage plan the company offered either. A good broker will help or Minnesota offers the SHIP help line too; I have only experience with them once and it was helpful.