HMO Plans
Health Maintenance Organization (HMO) Plans are a type of Medicare Advantage policy. They are sold through private insurance companies and each plan can vary in benefits and providers covered.
Medicare Advantage
Medicare Advantage Plans are health plans designed by insurance companies with the goal of expanding on the basic coverages afforded to you by your original Medicare. They often require you to join a hospital network and require copays for many provided services while providing a cap on your annual out of pocket expenditures. In many cases they will also include the CMS required prescription drug coverage or PDP in the plan. Also wrapped into many plans are ancillary benefits not offered by original Medicare or Medicare Supplement plans, such as Dental, Vision and/or Hearing allowances.
HMO Specifics
Each HMO Plan has a specific network of providers that are within the policy’s coverage. Beneficiaries are always encouraged to go to these providers for medical care as going outside this network can result in expensive out-of-pocket costs.
There are some situations when beneficiaries can go outside of their network and still get equal or near comparable coverage. For the most part, emergency care can be sought out-of-network. In cases when an individual does receive care outside of their network, it may be evaluated on a case by case basis.
The majority of HMO Plans ask beneficiaries to select a primary care doctor. They can write referrals and direct care to specialists within your network. If you would prefer to not select a primary care doctor, consider enrolling in a PPO Plan instead.
Research Your Area
If you’re wanting to begin the process of finding an insurance provider and policy, the first step is to research what’s offered in your area. Understanding what network each HMO policy includes is extremely important, as you’ll be relying on those professionals for the majority, if not all, of your medical care. When enrolling in a policy, be sure that you’re comfortable with what it offers and the network it includes.
