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.

How Does a Medicare Advantage HMO Plan Help Me?

A Medicare Advantage plan offers more benefits than Original Medicare with minimal to no extra premium. These advantages can be:

  • fitness memberships
  • over-the-counter drugs
  • adult day-care services
  • transportation to doctor’s offices
  • nutrition and wellness programs
  • And more

The benefit of having the network of healthcare providers is a lower monthly premium than most Medicare insurance plans.  

Your eligibility for benefits will vary depending on your area and plan providers. Like PPO Plans, Medicare Advantage HMO plans are offered by private insurance companies, and most plans cover prescription drugs. Again, it’s wise to check with an experienced Medicare specialist to see what benefits are available in your area. 

Also, you will likely have to select a primary care physician who will refer you to a specialist.

When Can You Enroll in Medicare Advantage?

There are set times when you can enroll in a Part C plan:

Initial Coverage Election Period (ICEP)

ICEP is a seven-month period that is your first opportunity to choose a Medicare health plan. It starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and you receive Social Security disability, you are eligible for Medicare in the 25th month after you begin receiving your Social Security benefits.  

Annual Election Period (AEP)

Also known as open enrollment, the AEP is October 15 through December 7 each year. Once January hits, coverage for your selected Medicare Advantage plan will begin. During this time, you may also add, change, or drop current coverage.   

Medicare Advantage Open Enrollment Period

During this period, you can switch from one Medicare Advantage plan to another. Or, you can end it to return to Original Medicare. 

Special Election Period

Many factors can stimulate a special election period and they are unique to an individual. It’s best to speak with a licensed Medicare insurance agent to find out whether you qualify for a special election period. However, there are a few common situations, like if you move outside your Advantage plan’s service area, move into a nursing home, or qualify for additional aid, you could be eligible for this special election period. You can institute changes to your Medicare Advantage plan during this period or go back to Original Medicare.

Get A Free Quote


How Are HMO and PPO Plans Different?

Medicare Advantage HMO and PPO plans are more alike than they are different. However, the main differences are:

  • PPO plans are more compliant, which means they typically have a higher premium.
  • PPOs allow you to visit doctors outside of the plan’s network, but it could cost you more in copayments. You cannot go outside of the network with an HMO. 
  • PPOs do not require a referral to see a specialist, while HMOs do.
  • You have to choose a primary care provider with an HMO, but not with a PPO. 
Contact Turning 65 Solutions For More Information

If you have questions about which Medicare Advantage plan is best for you, we can help. Call 800-515-4031 to speak with a Texas State licensed insurance broker.