What Is a 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 2020 are HMO plans.1

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.


  • 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) is only about $36 per month in 2020, in addition to your Part B premium.1

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.

Learn more about Medicare Advantage plans in your area and find an HMO plan that fits your coverage needs and your budget.

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