Medicare Advantage HMO Plans

A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage Plan that generally provides healthcare coverage from doctors, specialists, or hospitals in the plan’s network. The anomaly is an emergency or urgent care situation. This is when you can get coverage outside of the plan’s network unless you are paying out of pocket.

High Maitnance Organization (HMO Plan)

An HMO plan is a type of Medicare Advantage Plan that provides health care coverage only from doctors, other health care providers, or hospitals in the plan’s network (except for emergencies). A network is a group of doctors, hospitals, and medical facilities contracting with a plan to provide services.

An HMO plan is sold by private insurance companies, like Turning 65 Solutions.  Most HMO plans include drug coverage, and other benefits like lower monthly premiums, vision, hearing, fitness memberships, etc.

How Does An HMO Plan Work?

The policyholder of the HMO plan must stay in the HMO’s network to receive coverage. This means that you will get no coverage if you go to the doctors and hospitals which aren’t contracted with this specific plan and you will need to pay for service in full (except for medical emergencies). Therefore, you must stay in your plan’s network to receive coverage. Other things that you need to take into consideration about an HMO plan are:

  • You need to choose a primary care physician: it is obligatory to choose a PCP who will coordinate your medical needs among other needs. Your PCP is the first go-to person when you have any health issue-related situation 
  • Referral to see a specialist is required: if you have, for example, problems with your skin and need to see a dermatologist you will need a referral from your PCP to get an appointment with one 
  • You must stay in your plan’s network: it is important to remember that, there is no flexibility in choosing doctors and hospitals which means there is no coverage for going to seek service outside of the HMO’s network 

Other provided benefits with an HMO plan are:

  • Adult day-care services
  • Dental
  • Fitness memberships
  • Hearing
  • Nutrition programs
  • Over-the-counter drugs
  • Services and support for those with chronic conditions
  • Transportation to doctor visits
  • Vision
  • Wellness programs

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What Is The Difference Between HMO and PPO Plan?

Unlike HMO plans, PPO plans provide more flexibility for their beneficiaries, With a PPO plan you can get coverage for going outside of a network but at higher costs.

Most PPO plans don’t require their beneficiaries to choose a primary care doctor so you can go to any hospital or doctor you would like. Another big difference is that with PPO referrals to see specialists are also not required.

Among these three main differences, there are no other huge differences because all MA plans must cover Parts A and B basic benefits of Original Medicare.

Also, all of them have additional benefits such as dental, vision and hearing included all in one plan.

Who Should Purchase An HMO Plan?

An HMO plan can be good for Medicare beneficiaries who don’t mind being tied to one doctor who will coordinate their every medical need. If you want more flexibility in choosing doctors and hospitals in and out of network then a PPO plan would be a much better choice. However, you still need to choose a plan that fits your budget to avoid out-of-pocket costs. With an HMO plan, you can pay full price for going out-of-network so before enrolling it is good to check which doctors and hospitals nearby accept this plan

We know that choosing the right Medicare Advnatage plan isn’t easy, but we at Turning 65 Solutions are experienced licensed Medicare brokers who can help you to choose the best plan for your need! Call us today!

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