What is Medicare Advantage HMO?

Provided as one of the options for Medicare Advantage, Medicare HMO is a health maintenance organization that provides qualifying services to Medicare beneficiaries. Often referred to as Medicare managed care plans, coverage with this type of policy gives you access to a specific network of doctors and hospitals in your local area. Your care will typically be coordinated by a primary care physician that you select yourself. If the case arises that you need more medical attention than your primary care physician can provide, they can refer you to a specialist within the network.

To be enrolled in Medicare Advantage HMO, you will also need to have coverage under both Medicare Part A and Part B, and live in the plan’s service area. Once enrolled, you will need to agree to only use the plan’s network for your care unless it is an emergency and you are out of the service area.

Some Medicare HMO plans will offer a feature that is referred to as an HMO-POS plan. This type of plan functions as a hybrid policy between the HMO and the Preferred Provider Organization plan. The POS policy allows beneficiaries to see providers outside of their normal network for specific healthcare services or during certain situations, such as traveling.