Medicare Advantage HMO Plans

One of the more common Medicare Advantage plans is the Health Maintenance Organization (HMO) plan.

HMO Basics

In an HMO plan, the plan members can only use the healthcare providers within the plan’s provider network if they want coverage for their care. This means that HMO plan members will pay less if they see these specific providers. However, care is not covered for out-of-network providers. This means that plan members will be expected to pay the full cost if their provider is out-of-network.

Pros of HMOs

The main pro of an HMO is the cost. Because these plans require their plan members to use in-network providers, this means lower monthly premiums and lower co-pays for services.

Cons of HMOs

The main con of an HMO is the lack of flexibility. You must pay the full cost if you want to see an out-of-network provider. This reduces the total number of doctors you can see. There are also strict rules in an HMO:

  • You must have a primary care doctor. This doctor must be in-network.
  • You will need referrals if you would like to be seen by a specialist.
  • You will be required to obtain prior authorization before receiving certain services. Prior authorization means that the doctor submits a request for insurance to cover a service before you receive it.

We are committed to helping you realize your health and financial goals by making you aware of all your options so that you can make the best choice for yourself and your family.

Is an HMO Right for You?

Medicare Advantage HMO plans have advantages and disadvantages. While these plans may save you money upfront, they can cost you significantly more money if you stray out-of-network. Choosing which Medicare Advantage is right for you can be challenging, but we’re here to help. If you want to know whether an HMO is right for you, give us a call today!

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