Health Maintenance Organization (HMO)
Medicare Advantage HMO plans are great for those who want local, consistent coverage at an affordable cost. It is perfect for those who don’t want to pay for coverage they don’t need.
How Do HMO Plans Work?
Health Maintenance Organization (HMO) plans are very flexible in terms of cost. Rather than including certain fees into the monthly premium, you pay as-needed. In other words, rather than including copayment/coinsurance costs in the monthly premium, you pay them as you use the service.
The plan will negotiate with healthcare providers to create a local network for you to receive care. This also helps to keep your costs down. Receiving care outside of the network will be more costly, but your out-of-pocket costs are limited if you need emergency care.
Coverage and Benefits
Medicare Advantage HMO plans cover in-network, primary care. These benefits include:
Prescription Drug Coverage in most cases
Personally-chosen primary care physicians
Professional specialist referrals
Emergency, out-of-area urgent care, and out-of-area dialysis
No referrals required for services such as yearly maintenance check-ups
HMOs vs. PPOs
Both HMO and PPO plans are privately-offered alternatives to Original Medicare, both offering the same coverage as Plans A and B as well as additional benefits, including most prescription drug costs. They both also rely on a curated network of healthcare providers.
The difference between these plans involves their management of their respective network. PPO plans will charge less for in-network care while still offering minimal coverage for out-of-network care.
HMO plans, on the other hand, do not cover out-of-network providers, choosing instead to focus on a specific zone. This greatly reduces charges by only covering costs as-needed. Both plans, then, have distinct benefits, and it is up to you to decide which will work best for your medical needs.
Out of Network Coverage
State Or Nationwide
No Referrals To See Specialist
Easy To Use
Low or No Premiums
Lower Out of Pocket Cost
Does Not Cover Out of Network