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Medicare HMO Plans

Medicare HMO Plans

What makes the HMO plans so popular among U.S. citizens? The HMO plans offer low premiums which are very enticing. In fact, some of the plans that are offered even have a $0 premium. To be eligible for an HMO you have to be already enrolled in Medicare Part A and B and also paying for those parts. When it comes to treatment and where you can receive it, in-network providers will be the main source to go to aside from a medical emergency. 

What is HMO Medicare?

HMO stands for a health maintenance organization in which those on Medicare can use the Medicare services tied into these organizations. The HMO plans belong to a network that manages sed plans and has select doctors and hospitals that are within it. With an HMO you will have a primary care physician that you go to for care. The insurance company that handles HMO plans will create contracts with specific physicians and doctors around the area that you reside in which will form the network you will use. 

In the chance you have a health condition that the primary care physician cannot treat, they will then refer you to a specialist network. Some plans might not even need a referral to get special care. 

The HMO plan does not replace Medicare Part B. Being enrolled in Medicare Part A and B is a requirement before enrolling in an HMO plan. Not only that, but the area you reside in also must be within the area the HMO plan covers. 

If you decide to enroll in an HMO plan, your care then goes through the plan’s network. Emergencies however do not go through the network.

Medicare HMO Features

  • The application for a Medicare HMO no longer has health questions. In the years before 2021, any Medicare Advantage plan contained one question which was asking if the client has end-stage renal disease. Today, however, this question is now gone from any application. 
  • Depending on the area you reside in, premiums might be lower than in other areas. Keep in mind that every year premiums do change so look out for an Annual Notice of Change letter that is sent out every fall. 
  • There is a local network made up of healthcare providers within the area you live in that are to be seen if you need care. Most plans as stated above in a previous section will have you select a primary care physician.
  • A Part D Medicare drug plan is also usually attached to an HMO plan. Double-check the drug list to see if the medication you are currently on is covered. 
  • With HMOs, you pay either coinsurance or co-pays. The co-pays depend on the service you receive, so bloodwork, doctor visits, etc. will vary on price for each one.