Medicare Advantage HMO Plans

Health Maintenance Organization (HMO) plans are an affordable type of Medicare Advantage plan that brings you low prices for covered services from contracted healthcare providers within the plan’s network. You get the coverage of Medicare Part A and Part B with the guidance that comes from having a primary care doctor, who can help you decide when it’s necessary to see a specialist. 

Intro 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 healthcare expenses.

You can find an HMO with or without prescription drug coverage. One with drug coverage will usually be labeled as an MA-PD (Medicare Advantage Prescription Drug).

HMO Coverage

HMOs offer the same covered tests, services, and items as those covered under Medicare Part A and Part B (Original Medicare). This means you have inpatient hospital and skilled nursing facility coverage, hospice care, home health care, preventive care, and medically necessary services.

Many Medicare Advantage plans offer additional benefits packages which you can purchase for additional premiums. These plans can 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 instead of purchasing a separate supplement plan for those benefits.

HMO Costs

For your HMO, you can expect to pay monthly or annual premiums, a yearly deductible, copayments for office visits and emergency care, and coinsurance once you have met your deductible. You will need to continue paying your monthly premiums for Medicare Part A and Part B while you have your HMO plan.

Your costs will be higher outside of the plan’s network because HMOs usually provide no coverage beyond the network of plan providers.

Plan Comparison

You will need to have a primary care doctor under an HMO and will need to get a referral from your doctor in order to see a specialist. Having the primary care doctor serves to reduce your healthcare costs because it can help you rule out when emergency or specialist care is needed. You may have to switch doctors if your current doctor is not in the plan’s network.

HMOs can be less flexible than PPOs because they do not offer you coverage outside of the plan’s network, leaving you with the full cost for services received outside of the network. The more restrictive nature of an HMO does give you the advantage of lower premiums than a PPO.

To find out whether an HMO is a good health insurance choice for you, or to learn more about the available Medicare Advantage plans in your area, call us toll free at 855-GO-AVILA or click the below button to request information.