HMO Plans
Medicare Advantage Plans can serve as alternatives to Original Medicare as they offer the same benefits and have additional benefits. Beneficiaries also have multiple plans to choose from, such as Health Maintenance Organization (HMO) plans.
How HMOs Work
HMO plans are a type of Medicare Advantage plan that are sold by Medicare-approved private insurance companies. Like other Part C plans, HMO plans provide the same coverage as Original Medicare, in addition to extra services such as prescription drug, routine dental care, and vision coverage.
HMO plans have a list of healthcare service providers to choose from. Enrollees must get medical services from providers that are within the network to avoid paying for the total cost of the services. HMO plans do not provide coverage for services received from out-of-network providers unless it is an emergency.
HMO plans also require beneficiaries to choose a primary care provider within the network and get referrals to see specialists.
Features
Even though HMO plans lack the flexibility of Preferred Provider Organization (PPO) plans, they are one of the cheaper options. As mentioned above, HMO plans can offer coverage for prescription drugs, dental, and vision care. However, other coverage benefits include:
- Hearing care
- Fitness memberships
- Nutrition programs
- Wellness programs
- Transportation
- Adult daycare services
To better understand what benefits you will get, ensure that you check with a licensed Medicare agent, like the ones with Simple Retirement Benefits, to know what is available in your area.
Original Medicare services that HMO plans cover include:
- Inpatient care
- Skilled nursing facility care
- Home health care
- Nursing home care
- Ambulance services
- Outpatient care
- Mental health care
- Durable medical equipment
- Clinical research
Enrollment
To enroll for Medicare Advantage HMO plans, you must be enrolled in Original Medicare. There are several enrollment periods you can take advantage of to enroll:
- Initial Enrollment: Your IEP begins three months before your 65th birthday and ends three months after your 65th birthday. This period is the best to enroll in and is highly encouraged so enrollees can avoid late enrollment penalties. However, if you are under 65 and receive Social Security disability, you can qualify for Medicare during the 25th month after you begin receiving these benefits. You can then enroll in a Medicare Advantage Plan three months before becoming eligible.
- Annual Enrollment: AEP begins on October 15 and ends December 7. During this period, beneficiaries can review their coverage and make changes if need be; this includes enrolling in a Medicare Advantage Plan or switching advantage plans.
- Special Enrollment: Certain situations can trigger a SEP that will allow beneficiaries to enroll in a new plan. For example, you can enroll in a Medicare Advantage Plan if you moved out of your plan’s service area or lost your coverage.
To know more about Health Maintenance Organization (HMO) plans and how they work, contact us today at 512-432-5414
