HMO stands for Health Maintenance Organization and is one type of Medicare Advantage plan. This is a very common Medicare Advantage plan that many seniors enroll in, but just because it’s common, does that mean it is right for you?
To answer this question, let’s go over how these plans work so you can determine if they will meet your needs.
HMO Plans Explained
With an HMO plan, you will have a Primary Care Provider (PCP) who will coordinate and approve your care when any issues arise. When services are required, you must use the medical care providers within your network as directed and approved by your PCP. If you seek medical care outside your network you will likely have to pay the full cost of any services.
When it comes to referrals and receiving care within your network, It’s very important to follow these rules to uphold the insurance contract. There are exceptions to the network rule which include emergency care, urgent care out of area, and emergency dialysis out of area. But otherwise, you can expect to see specialists and get treatments at the discretion of your PCP.
For this reason, it is very important to have a strong and trusted relationship with your PCP. You will want to choose carefully and ask plenty of questions when seeking out your care coordinator. Most individuals find that with the right PCP, the restrictions of an HMO plan are perfectly acceptable. There are millions of people with various kinds of HMO plans across the country who are satisfied with their care.
HMO Plans vs. PPO Plans
HMO plans may offer less flexibility than PPO plans generally speaking, but there are still many benefits to a Medicare Advantage HMO plan. These plans tend to be the most affordable and offer lower out-of-pocket costs than other options. Additionally, the goal of an HMO plan is to keep the individual healthy. There is a high emphasis on preventative care and early diagnosis in hopes of needing less treatment in the long run. If you don’t require a lot of specialty care, an HMO plan could save you a lot of money in the long run.
Need Coverage? We Can Help
To get the most out of your coverage be sure to consult with one of our experienced agents. They can compare your Medicare Advantage options to make sure you get a policy that works for you. We will help you understand the complexities of a Medicare Advantage plan so you can enjoy peace of mind knowing you are properly covered.
