Medicare Advantage HMO Plans
One of Medicare Advantage’s most popular plans is the Health Maintenance Organization (HMO) plan. It offers coverage for inpatient, outpatient, and in many cases, prescription medications under the same plan. It’s convenient, reasonably priced, and comprehensive.
What Do HMO Plans Cover?
HMO plans offer the combined coverage of Medicare Part A, B, and D. It will help cover your hospital and other inpatient facility costs. This includes your room and board, medications, and meals.
This also translates to outpatient treatments and services, even those that Original Medicare omits from its plan (i.e. dental, vision, and hearing). That includes your screenings and exams, as well as immunizations and durable medical equipment.
Prescription coverage varies from one plan to another, as Medicare Advantage comes through private insurance only. Your coverage is according to a formulary, or list, of medications that your plan covers.
If your particular HMO plan does not provide prescription coverage, you can enroll in a separate Medicare Part D plan.
How Do They Work?
When you sign up for an HMO plan, your coverage will be effective within a provider network. You will only be able to get coverage from providers who accept your specific policy. Just because a healthcare professional accepts Medicare does not mean he or she will accept your HMO policy.
You will need to choose a primary care physician, and you’ll need referrals when you need to see specialists. The primary care physician will coordinate the direction of your medical care.
Out-of-network providers may refuse to treat you in a non-emergency situation, even if you have gotten treatments from them in the past.
However, you do have the option to join a modified form of an HMO, known as the HMO Point-of-Service (HMOPOS). This is a way to circumvent the network limits, as this plan offers out-of-network benefits.
What Should I Consider?
As is the case with other Medicare Advantage plans, HMOs come with restrictions. You won’t be able to have a Medicare Supplement in addition to your plan. You also cannot have an HMO plan alongside an employer group health plan. Doing so can cause you to lose employer coverage, and possibly no way to recover your group health plan.
Who Is This Right For?
HMOs are great for anyone interested in Medicare Advantage. Its comprehensive coverage makes it one of the most appealing choices in Medicare. While the restricted network may seem like a limitation, it can also help with familiarity, giving providers a chance to make continuous improvements in treating your conditions. In the end, an HMO can contribute to a longer, fuller life while keeping the money in your pocket.
Get The Plan You Deserve
If you’re looking for a way to get an HMO plan, you’re in luck. At Peritia Advisors, we will get you the very plan you’re looking for, with the best benefits at the lowest price. We will sort through all the options, and give you the best plan possible. Our experience and dedication will work in your favor.
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