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Medicare HMO Plans

We can help you make sense of California Medicare HMO Plans!

Medicare has authorized these plans since 1985 and at one time was the only option other than Medicare Supplements available in California. Medicare HMO plans are not available in every county and are subject to benefit changes on an annual basis. Where they are available, there are virtually no health questions.

Some people incorrectly believe that their physician works for the HMO. The reality is the HMO is simply an insurance carrier who pays a medical group to provide you with health care. (The only exception to this is Kaiser as they are both the insurance company and the medical group). The large medical group your doctor joined either as an independent or employee likely works with many HMO plans.

The advantage of an HMO is that virtually all medical needs are provided initially by your choice of personal physician. It is that doctor who will refer you to specialists. By working in this manner, one doctor has the responsibility of coordinating your care. The drawback is you cannot always see the specialist of your choice.

Most Medicare HMO plans will include your prescription drug plan. They also can provide you with routine vision care and glasses, dental benefits, and even transportation. And many plans are available with no additional premium to what is already deducted from your social security for Medicare Part B.

Since benefits will change on an annual basis, please take the time to review your options. Since your doctor likely works with many plans, choose the one with the lowest cost for services and the broadest spectrum of benefits.

While it is a great benefit that most Medicare HMO plans include your drug coverage, it also means that you will need to make sure your medications are on the HMO Rx formulary. For example, the doctors benefits might be wonderful but the HMO might not cover your prescription medication. This would leave you paying the full amount of the prescription out of pocket.

We see this mistake all too often. For example, we worked with a client last year that picked an HMO because it had a 10 dollars co-pay at the doctor versus a 20 dollars co-pay with another company. However, the HMO with the cheaper copay did not cover one of her more expensive prescription medications. She had to pay 169 dollars per month for her pills. She could have picked the company with the 20 dollar copay at the doctor and it WOULD have covered her medication. Instead of paying 169 dollars per month she would have paid a small 30 dollar copay. This ended up being a 1500 dollar per year mistake.

The moral of this story is to sit down with a licensed agent that can go over the fine details as outlined in the Summary of Benefits. Often, the lowest doctors co-pay plan might not be the best plan for you. We look forward to talking with you!

We can help you choose a great Medicare HMO plan for your situation. Call on us anytime.

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