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Medicare HMO Plans


What Are Medicare HMO Plans?

While Medicare HMO plans can reduce your cost of care and generally have little or no monthly cost, there are restrictions. On the plus side these plans usually cover not only what Original Medicare provides, but add other benefits you may not otherwise have.

With this plan, you must get your care from doctors, care providers, or hospitals in the plan’s network and within the provider group the doctor has an affiliation. You need to be aware of the network of physicians and facilities that the HMO plan is contracted with.

With the Medicare HMO plans, you must be in the network at all times except for emergency care or out-of-area urgent care. If you choose to see a provider outside the network for routine care you will be responsible for the cost, not the HMO.

In most cases Medicare HMO plans require a referral to see a specialist. There may be some exceptions to this rule and these vary by plan. The Medicare HMO plans also require authorization for most procedures and some expensive brand drugs.

Is a Medicare HMO Plan Right For You?

Everyone has different wants and needs when it comes to health coverage. You need to consider if you can keep your doctor. If you have a primary care doctor that you wish to continue to see, then you have to ensure that the doctor is in the HMO’s network. It’s even more important with a specialist who not only needs to be in the HMO plan, but must be in the same medical group as your primary care physician. This is why it’s so important to use a professional to assist in this decision.

You should also consider that you will likely need an authorization for a referral to a specialist. This can be very quick in the event of an urgent need, or take a bit of time for a routine referral.

Finally, consider the cost. Most times, the HMO will save you some or all of the monthly premium you might pay for a Medicare Supplement. But keep in mind that there may be higher costs for some procedures. This information is found in the summary of benefits. Please make sure you understand the potential out of pocket costs. Nobody likes surprises!
We look forward to talking with you! We have the expertise to help you choose a great Medicare HMO plan for your situation. Call on us anytime.

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