HMO Plans

Medicare Advantage plans offer another route to receiving your Original Medicare benefits. A wide range of programs is available in most states, and it pays to work with an agent who specializes in Medicare Advantage.

You'll want to look over each plan closely so you can make an informed choice. It's equally important to understand how the various Advantage plans operate and what you'll pay for coverage.

One favorite among many Medicare beneficiaries is the Health Maintenance Organization (HMO) plan. Quottes is here to answer the questions people commonly ask about HMOs.

What Is an HMO?

Health Maintenance Organization (HMO) plans are built around a network of health care providers (hospitals, doctors, and the like) who agree to coordinate care within that network in return for a set rate for their services.

Put simply, an HMO gives you access to particular hospitals and doctors that belong to the plan's network.

Why Choose an HMO?

An HMO plan can help you stretch your health care dollar further. These programs usually come with affordable, fixed costs and deliver all the benefits of Original Medicare—PLUS some extra features.

What You Should Know

As an HMO patient…

You're generally required to obtain services from a local provider network.
You must see your primary care physician (PCP) first. If the PCP can't handle the issue, they'll refer you to an in-network specialist.
By staying within your "network," you can count on the maximum coverage your plan allows for the services you receive.
You get coverage for most annual screenings at no cost!
HMOs typically don't have yearly deductibles and only charge a copayment at the time of service (when you're in network).

Because the copayments are predictable, it's easier to plan your budget around them.

Important Note: If you get care outside the provider network, you'll most likely have to pay all the costs out of pocket, unless it's an emergency.

Who Qualifies for an HMO?

If you're already enrolled in Original Medicare and live within the plan's coverage area, you qualify for an HMO plan. You cannot drop Part B.

Do You Need to File a Claim?

No, because the insurance company pays the health care provider directly.

What If You Need to Fill a Prescription?

To get coverage, you must have your prescriptions filled at in-network pharmacies.

When Can You Apply?

There are four main enrollment periods during which a person can join an HMO plan:

Your Initial Enrollment Period (IEP)
General Enrollment Period (GEP)
Annual Enrollment Period (AEP), and
Medicare Advantage Open Enrollment (OEP)

Your IEP is a seven-month window that opens three months before your 65th birthday and closes three months after it. The GEP and OEP run from January 1 to March 31. The AEP takes place from October 15 to December 7. These timeframes let a person enroll in, switch, or leave an Advantage plan.

Quottes Can Help

If you're weighing whether an HMO plan makes sense for you and your budget, we can help. Begin with a FREE quote—contact us online or call 941-894-6460 today!