Choosing the best healthcare coverage at an affordable price can feel like a daunting task, especially as we age and transition into Medicare. You may come across terms like “HMO” in your research, but what exactly does it mean?
First let’s establish what an HMO is. HMO stands for health maintenance organization. It’s a type of insurance plan that offers comprehensive healthcare coverage through a provider network. Many HMO plans are budget-friendly and focus on preventive care.
How a Medicare Advantage HMO Plan Works
An HMO network is made up of doctors, hospitals, and other providers that your insurance company contracts with for services. The plan covers care received through these in-network providers. While this limits your ability to choose your own providers, it helps ensure that you receive high-quality care at an affordable cost.
HMO Costs to Consider
An HMO plan offers lower monthly premiums, copays and deductibles compared to PPO and POS plans. It can be a good option for people seeking coverage for routine check-ups, immunizations and screenings.
HMO Choice of Providers
HMO coverage is limited to a select group of providers that are part of the plan’s network. These providers are contracted by the plan to provide care to their members for a set fee. This provider network is one way that HMO plans keep costs predictable. Should you see a provider or specialist outside of your plan's network (unless it’s an emergency), you will likely be charged a higher co-pay.
Primary Care Provider
Much of your care with an HMO is centered around your in-network primary care provider (PCP). Your PCP serves as your main point of contact for medical care. Many people choose an HMO plan if their preferred physician is already in-network.
If there is a specific condition that falls outside their expertise, they may provide a referral for an in-network specialist. This ensures coordinated, cost-effective care for members.
Is an HMO Plan Right for Me?
Weigh the pros and cons of HMO plans as compared to PPO and other types of plans. Lower costs, coordinated care and limited provider choice are all factors to take into consideration.
Also take into account your geographic area since HMOs vary by region. Larger cities and densely populated areas often have larger networks, which means more providers to choose from. Go to the plan website or call for a list of in-network doctors, medical groups, hospitals and labs.
Enrolling in a Medicare HMO Plan
You are eligible to enroll in a Medicare HMO plan during several designated time frames. The first is your Initial Enrollment Period (IEP) when you turn 65. You can also enroll during the Annual Enrollment Period from October 15 to December 7 each year, or during a Special Enrollment Period if you qualify. Call us today for more information and to explore your Medicare Advantage plan options.
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More About Medicare Advantage
- What Is a Medicare Advantage Plan?
- What Is a D-SNP? Understanding Dual Special Needs Plans
- What Is a PPO?
- Dual Eligible Special Needs Plans (D-SNPs): Frequently Asked Questions (FAQs)
- Medicare HMO vs. PPO Plans: What’s the Difference?
- Medicare Advantage vs. Original Medicare
