Medicare Health Maintenance Organization (HMO) refers to the private plans that the USA’s Federal government payments to private companies for administering the Medicare benefits. Like other advantage plans of Original Medicare, HMOs provide the same rights, benefits, and protection. However, these plans do that with different restrictions, costs, and rules. Some HMO plans offer additional benefits, such as hearing care and vision.
Benefits and Coverage of Medicare HMO Plan
When an individual joins the Medicare Advantage HMO plan, he/she receives a benefits card from the plan. The individuals can use their HMO benefit card instead of a Medicare card to visit or consult medical professionals or hospitals.
In most HMO plans, the beneficiaries must consult in-network healthcare providers to obtain coverage, unless they need emergency medical assistance. Some advantage HMO plans include a point-of-service (POS) that allows beneficiaries to visit network doctors for certain services. However, it is important to know that these plans or services may cost you a higher amount.
Note that Medicare Advantage HMO plans are not readily available everywhere. You need to contact the State Health Insurance Assistance Program (SHIP) or call at 1-800-MEDICARE to determine if your State provides an HMO plan in your area. You can enroll in the Medicare Advantage HMO plan by calling Medicare directly.
Eligibility, Coverage, and Cost of HMO Plans
Keep in mind that beneficiaries need to have Part A and B coverage to enter a Medicare HMO plan. In general, a beneficiary continues paying his or her premium for Medicare Part B. However, some HMO plans pay part of these premiums.
Know that some HMO plans can cost you an additional premium, along with a Part B premium. And if you need Part D coverage, you can receive it via the HMO plan. These plans may also charge a relatively higher premium if you already have drug coverage.
It is essential to obtain coverage from a plan if you enter a Medicare Advantage Plan and qualify for Part D coverage. That means if you don’t join Private Fee-for-Service (PFFS) plan, a Medical Savings Account (MSA), or something that doesn’t offer any prescription drug coverage, enrolling Part D coverage stand-alone is not possible.
Typically, you can’t receive an HMO if you’re an End-Stage Renal Disease (ESRD) patient. You will only be eligible if you enroll in the Medicare HMO before developing ESRD symptoms.
In short, Medicare Advantage HMO plans have provider networks to help beneficiaries keep the costs down. But beneficiaries should stay within the network of the health providers to get medical care.
Bottom Line
In a nutshell, HMO plans, like other Medicare Advantage Plans, aim at offering individuals lower cost of medical treatments. They are available via a private insurance company to deliver Medicare benefits. However, it strictly uses the provider’s network and has slightly different eligibility requirements. Be sure to contact a plan representative at Hitcho Insurance to make an informed decision. You can ask all your Medicare questions by calling us at (610) 694-9435.