Medicare HMO

Thinking about switching to Medicare Advantage? If so, you may want to consider a Health Maintenance Organization (HMO) plan. These health insurance plans offer numerous benefits, making them a popular choice for seniors.

Older adults smiling after group exercise

Understanding HMO plans

Medicare Advantage recipients have several options for the type of plan they’ll receive coverage under, including Medicare HMOs, Preferred Provider Organizations (PPOs), private fee-for-service plans (PFFS), and special needs plans.

But even with the diversity of options, 64 percent of all Medicare Advantage plans offered in 2019 will be HMO plans.*

Under most HMO plans, you can receive health care only from providers that are within the plan’s network, except in the case of an emergency.

Additionally:

  • Many HMOs offer prescription drug coverage
  • In most cases, you’ll need to select a primary care physician under your Medicare HMO
  • Most HMOs require that you receive a referral to see a specialist
  • You may have to pay the full cost of service if you go out of network

Why choose a Medicare Advantage HMO plan over Original Medicare?

Every senior likely has his or her own reason for choosing Medicare Advantage, but for many, the reasons to choose Medicare Advantage come down to these details:

  • Medicare Advantage plans often include additional benefits that can cover dentistry, eye exams, and other services
  • HMO plans may offer cost savings to their beneficiaries, as compared to Original Medicare or other Medicare Advantage plans
  • The average Medicare Advantage premium for a Medicare Advantage plan that offers prescription drug coverage (MA-PD) was only about $36 per month in 2017, in addition to your Part B premium.**

Is a Medicare HMO right for you? There’s no simple answer to this question, though a couple factors (such as cost and the size of your HMO network) can help you make an informed decision.

Speak with a licensed insurance agent at TTY Users: 711 for more information about Medicare Advantage plans available in your area.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

*Kaiser Family Foundation. Medicare Advantage 2019 Spotlight: First Look. (Oct. 16, 2018). Retrieved from www.kff.org/medicare/issue-brief/medicare-advantage-2019-spotlight-first-look.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.