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.

What does Medicare Advantage HMO Cover?

Medicare HMO is a popular plan, and one of the first options that many people look to when searching for Original Medicare alternatives. One of the big reasons for this is that anyone can enroll in the plan as long as the beneficiary does not have End-Stage Renal Failure. Another reason for the plan’s popularity is premiums will be lower than Medigap plans in certain service areas. As with Medicare PPO, Medicare Part D is a part of this plan and will help shoulder some of the costs for prescription drugs throughout the year if they are needed.

Another area of coverage that makes Medicare Advantage HMO a great alternative to the Original Medicare plan is that it provides options for vision, hearing, and dental care. Depending on who your insurer is and your network’s service area, there could be different costs or services that are part of each individual HMO plan. However, most will cover the normal routine care such as yearly exams, cleanings, fillings, and even at times the costs for hearing and seeing aids.

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Over the past 20 years, Hitcho Insurance has been helping clients and their family protect what matters most. To start coverage today or learn more about your options, request a consultation with one of our agents by giving us a call at (610) 694-9435.

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