A HMO, or Health Maintenance Organization, is a type of Medicare Advantage plan. HMO plans always offer the same benefits as any other Medicare plan, but they are also able to provide additional benefits, many including vision, dental, and even gym memberships. HMO plans are different from other Medicare Advantage plans because they require a strict network and you will usually need to select and stick with one primary doctor.
Pros and Cons of HMO Plan Networks
The HMO option is certainly not for everyone. Having a strict network means that you will turn to the same doctor for most of your healthcare needs. Some plans are called “HMO POS,” or HMO Point-of-Service plans. These allow you to see providers outside of your network for certain services. If you need to use that benefit, you will usually have to get approval from your plan first, and your provider needs to recommend the other provider. For example, if your primary physician suggests that you need to see a nutritionist or other specialist, he can refer you to a nutritionist that he trusts and send a request for coverage to your HMO. The “con” to the HMO option is that your plan can deny your out-of-network coverage.
The “pro” to selecting one primary physician and having a Health Maintenance Organization is that all of your care is grouped together and managed in one place. Your providers usually work together to manage your care, preventing unnecessary costs.
Medicare HMO vs PPO
Where an HMO requires a very specific network, a PPO, or Preferred Provider Organization, can cover services outside of your network. With a PPO plan, you’ll be able to see any provider without needing a referral from your primary physician. Granted, the added flexibility of a PPO plan comes with a higher premium than an HMO plan. If costs are your primary concern, HMOs are the way to go – but if you can afford the flexibility, a PPO may be for you.
What is Medicare Advantage?
Medicare HMO plans and other types of Medicare Advantage plans are great options for people who want more coverage than what Original Medicare provides. Original Medicare is what everyone who has Medicare will have, but its coverage is limited. Medicare Advantage plans can add anything from extra medical coverage to additional benefits like home healthcare, telemedicine, and full dental coverage.
HMO Eligibility and Costs
Most people who are eligible for Medicare are eligible for HMO plans. The only exceptions are that not every county has HMO plans available, and most HMO plans do not accept Medicare beneficiaries with ESRD (End-Stage Renal Disease).
Just like your Original Medicare coverage, you will receive a card in the mail when you enroll in a HMO plan. When you visit a doctor or hospital, use your HMO card instead of your Medicare card to get the most coverage.
Medicare Advantage HMOs Near You
Medicare Advantage HMO plans are not available in every zip code. However, we have agents in 38 states who can help you discover the options available in your neighborhood. To get started, send us a message or give us a call at 833-438-3676.