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
- Fitness memberships
- Nutrition programs
- Over-the-counter drugs
- Services and support for those with chronic conditions
- Transportation to doctor visits
- Wellness programs