Medicare Advantage HMO Plans

Health Maintenance Organization (HMO) plans are one of 5 Medicare Advantage plans. They are perfect for those who want low-cost, network-based coverage at a very low cost.

How an HMO Plan Works

The best way to understand HMO is to break it down into its key features:

  • Network: HMO plans have a provider network. This network is a collection of doctors, hospitals, etc. in a certain area that will accept your Advantage plan. Using in-network providers will ensure you receive coverage and pay less out-of-pocket compared to using out-of-network providers.
  • Primary Care Doctor: Some Advantage plans, including HMO, require you to have a primary care physician. This is a doctor that you are required to visit before receiving other treatments or check ups except in the case of an emergency. Once again, this system helps keep costs very low.
  • Specialist Referral: Along the same lines, HMO plans require a referral before seeing an in-network specialist.
  • Out-of-Network Treatment: The network for an HMO plan is limited, but comes at a significantly lower out-of-pocket and premium cost than other plans. It is very network-focused as a result, so any care received outside of said network will not be covered.

What HMO Covers

This is an introduction to the way in which HMO plans cover a majority of your costs. Here are the main features of HMO:

  • In-network care (except for emergency visits, out-of-area urgent care, or out-of-area dialysis)
  • Required primary care doctor
  • Required specialist referral
  • Prescription drug coverage

As you can see, most HMO plans will also include Part D prescription drug coverage. This is an extremely vital service to Medicare beneficiaries. Most Advantage plans (HMO included) will also cover basic, limited dental, vision, and hearing care. Keep in mind, however, that every plan varies.

We Have Your Back—Call The Coleman Agency

You know what health insurance works best for you, you just need someone to help you get it. The Coleman Agency will work with you to get the coverage you need at a good price. To learn more, give us a call today.

Related Articles

Get Your FREE
Quote Today