Wondering what HMO coverage options are right for you
Understanding How HMO Coverage Works
Choosing the right health insurance can be confusing — especially when it comes to Health Maintenance Organization (HMO) plans.
Let’s explore what HMO coverage includes, how it works, and whether it fits your healthcare needs.
What’s an HMO Plan?
A Health Maintenance Organization (HMO) is a type of Medicare Advantage Plan (Part C) offered by private insurance companies approved by Medicare.
With an HMO, you generally must get your care and services from doctors, hospitals, and other providers that are part of the plan’s network.
Emergency care, urgent care while traveling, and temporary kidney care (dialysis) outside of your area are usually still covered.
Common Questions About HMOs, Do HMO Plans Have Monthly Costs? Most HMO plans charge a monthly premium in addition to your Medicare Part B (Medical Insurance) premium.
Are Prescription Drugs Covered?
Usually. Most HMO plans include drug coverage (Part D).
If having drug coverage is important to you, make sure to join a plan that offers it. If your HMO doesn’t include drug coverage, you cannot enroll in a separate Medicare drug plan.
If having drug coverage is important to you, make sure to join a plan that offers it. If your HMO doesn’t include drug coverage, you cannot enroll in a separate Medicare drug plan.
Can I See Any Doctor or Hospital?
Usually. Most HMO plans include drug coverage (Part D).
If having drug coverage is important to you, make sure to join a plan that offers it. If your HMO doesn’t include drug coverage, you cannot enroll in a separate Medicare drug plan. Some HMO plans, called HMOPOS (Point-of-Service), may let you get certain services outside of the network for a higher cost.
Important Things to Know:
If having drug coverage is important to you, make sure to join a plan that offers it. If your HMO doesn’t include drug coverage, you cannot enroll in a separate Medicare drug plan. Some HMO plans, called HMOPOS (Point-of-Service), may let you get certain services outside of the network for a higher cost.
Important Things to Know:
- If you get care outside of the plan’s network, you may have to pay the full cost of the service.
- If your plan gives prior approval for a treatment, that approval stays valid for as long as the treatment is medically necessary.
- If you are in treatment and switch to a new plan, your new plan must honor your treatment for at least 90 days before requiring a new approval.
- If your doctor or provider leaves the plan, the plan will notify you, and you can choose another provider in the network.
HMO plans cannot charge more than Original Medicare for certain services such as chemotherapy, dialysis, and skilled nursing facility care.
