Medicare Advantage HMO Plans
Health Maintenance Organization (HMO) plans are an affordable type of Medicare Advantage plan that offers you low prices for covered services from contracted health care providers within the plan's network. You get Medicare Part A and Part B coverage with the guidance that comes from having a primary care physician who can help you decide when you need to see a specialist. For more information about HMO plans in your area, talk to an Avila Medicare Solutions agent.
Introduction to HMO
A Health Maintenance Organization (HMO) is a type of Medicare Advantage plan. As a form of Medicare Advantage, an HMO gives you the same coverage as Original Medicare but from a private insurance company. These private health insurance companies have been approved by Medicare to handle your Part A and Part B coverage. Medicare compensates these companies for taking care of your health care expenses.
You can find an HMO with or without prescription drug coverage. One with drug coverage will generally be labeled MA-PD (Medicare Advantage Prescription Drug).
HMO Coverage
means inpatient hospital and skilled nursing facility coverage, hospice care, home health care, preventive care and medically necessary services.
Many Medicare Advantage plans offer additional benefit packages that you can purchase for additional premiums. These plans may include prescription drug coverage, vision care, dental care, hearing care and more. Choosing these benefits is a convenient way to get your coverage from one provider rather than purchasing a separate supplemental plan for those benefits.
HMO costs
For your HMO, you can expect to pay monthly or annual premiums, an annual deductible, copayments for office visits and emergency care, and coinsurance once you have met your deductible. You will need to continue paying your monthly Medicare Part A and Part B premiums as long as you have your HMO plan.
Your costs will be higher outside the plan's network because HMOs generally do not provide coverage beyond the plan's provider network.
Plan comparison
You must have a primary care physician under an HMO and you must get a referral from your doctor to see a specialist. Having the primary care physician serves to reduce your health care costs because he or she can help you rule out when emergency or specialty care is needed. You may need to change doctors if your current doctor is not in the plan's network.
HMOs may be less flexible than PPOs because they do not offer you coverage outside the plan's network, leaving you with the full cost of services received outside the network. The more restrictive nature of an HMO gives it the advantage of lower premiums than a PPO.
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