Medicare Advantage network providers

What Is A Medicare Advantage HMO Plan?

While Medicare Advantage plan providers do offer five different Medicare Advantage or MA plans, a Health Maintenance Organization (HMO) Plan is a very common plan to choose. In order to enroll in an HMO, you must first be enrolled in Medicare Part A and Part B. Once you have joined a Medicare Advantage HMO Plan, you are still responsible for the Medicare Part B monthly premium. Some HMO plans will cover part of the cost of the monthly premium for you. Other HMO plans may charge an additional premium on top of the Medicare Part B monthly premium. You are also able to receive prescription drug coverage through your HMO plan. 

Medicare Advantage Costs And Providers 

Medicare Advantage HMO plans have the option to set their own deductibles, copays, and other service prices. They are required to set a limit on your out-of-pocket expenses, though. This protects you from spending a large amount of money out of your pocket if you require extensive medical care or expensive treatments. As of 2021, the out-of-pocket limit amount cannot exceed $7,550 for in-network services. HMO plans do have the option to set this limit lower within their plan. One thing most Medicare participants do not know is that Medicare Advantage Plans cannot charge more for coverage than Original Medicare charges for coverage for certain types of care. Examples of these types of care include dialysis, chemotherapy, or receiving care from an SNF, or skilled nursing facility. HMOs do have the ability to charge you higher copays for other services that both plans provide, such as home health costs, durable medical equipment (DME) costs, and inpatient hospital care costs.

When enrolled in an HMO, you are required to choose a primary care physician who maintains your health and wellness. Your doctor will most likely have to issue a referral if you need to visit a specialist. Unless you must receive emergency care or urgent care, then you will most likely receive no coverage from your HMO plan due to you seeking treatment from an out-of-network provider. If you must seek emergency care or urgent care, your plan is required to cover your costs, regardless of whether the physician or hospital is within their network or not. You must also remember that your physician has the option to leave your HMO plan’s network at any time, but your Medicare Advantage HMO Plan provider should notify you if this circumstance arises. 

To sum up a Medicare Advantage HMO Plan, this is what you need to know:

You will most likely receive prescription drug coverage from your plan, and in order to receive coverage for any medical visits or medical treatments, you must choose a primary care physician that is within your HMO plan’s network. The only time you do not have to abide by this requirement is when you are seeking emergency care or urgent care. HMOs can increase copays on some services, but not all. 

To answer all your Medicare Advantage HMO questions that you may still have, contact one of our trusted and well-educated agents to ensure you receive the benefits that are best for you.