HMO Plans

There are different types of Medicare Advantage plans, there are PPO plans, HMO plans, SNPs, and PFFS plans. Each plan has its coverage rules and options. HMO stands for Health Maintenance Organization plans. These types of Medicare Advantage plans provide healthcare services through a network of providers. 

What Are HMO Plans?

HMO plans are one of the types of Part C plans. There are other types such as Special Needs Plans, Preferred Provider Organization Plans, and Private Fee-For-Service Plans. Health Maintenance Organization plans are provided by private insurance companies that are approved by Medicare. The plans are regulated and must at least cover the same services as Original Medicare. Like other Medicare Advantage plans, HMO plans may also offer extra services such as prescription drug coverage, dental care, and vision. 

Health Maintenance Organization Plans require in-network healthcare. Due to this, enrollees are expected to choose from a list of healthcare providers that are within the Medicare Advantage network. Beneficiaries must then get medical services from these providers, to avoid covering the full cost of medical services if they elect to go out-of-network.

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What Do They Cover?

Like the other Medicare Advantage plans, HMO plans must cover the same services Medicare Part A and Part B cover.  HMO plans cover hospice care, home healthcare, skilled nursing facility care, and hospital insurance. Health Maintenance Organization plans also cover outpatient medical services such as preventive screenings, durable medical equipment, and other healthcare services. In addition, most Medicare Advantage plans some outpatient services such as prescription drug coverage and extra services.

How to Enroll

One of the eligibility requirements for Medicare Advantage plans is to have Medicare Part A and Part B. If you have a Medicare Supplement plan, then you’re not allowed to enroll for Medicare Advantage while you still have a Supplement plan. If you’re eligible for Medicare Advantage, then you can join, switch, or drop a program during the open enrollment period — from October 15 to December 7 every year.

Health Maintenance Organization plans have a list of providers in the network with specific guidelines for out-of-network care. 

For example, HMO plans will only cover out-of-network medical services if you need urgent care as a result of an emergency or you need dialysis when traveling. Some HMO plans may allow you to go out-of-network under some conditions, but you’ll pay more out-of-pocket costs.

Key Features of HMOs

HMO plans have a network of medical care providers and you are required to stay within the network unless in certain cases. Many Health Maintenance Organization plans provide prescription drug coverage but it’s important to confirm before registering for the plan. If you need to visit a specialist, you’ll need a referral, except for some preventive screenings like mammograms. 

HMO plans allow you to visit any healthcare provider so far they are within the network. Like other Medicare Advantage plans, HMO plans have premiums, copayments, and deductibles. Some plans have deductibles as low as $0 with generally available copayments. 

All HMO plans have a yearly cap for out-of-pocket costs. This limit varies based on the coverage and provider. If your doctor is within the plan network, then you can keep visiting them. If they’re out-of-network, then you’ll need to choose another physician within the network. Since HMO plans are quite popular, there are a variety of plans and in-network providers to choose from.

Looking for the Right Advantage Plan?

Medicare Advantage HMO plans are a popular choice for Medicare Advantage enrollees. At Better Place Insurance Group, we can help you find the best Part C plan for you if you live in Florida. For more information, or to get a quote, contact us today.