NC Health Coverage, Al Crouse - NC Health Insurance  

Medicare Advantage HMO Plans

Medicare Advantage HMO Plans


What is a Medicare Advantage HMO Plan?

A Medicare Advantage HMOplan, or a Health Maintenance Organization plan, covers Medicare beneficiaries who must get care and services from doctors or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some plans, an individual may be able to go out-of-network for certain services, usually for a higher cost.


Covered Benefits under a Medicare Advantage HMO Plan


Health Maintenance Organization (HMO) Plan


Are prescription drugs covered?

In most cases, yes. Ask the plan. If you want drug coverage, you must join in an HMO Plan that offers prescription drug coverage.

Do I need to choose a primary care doctor?

In most cases, yes.

Do I have to get a referral to see a specialist?

In most cases, yes. Yearly screening mammograms and in-network Pap tests and pelvic exams (at least every other year) don't require a referral.


Things to Consider before enrolling in a Medicare Advantage HMO Plan

  • If your primary care physician leaves the HMO plan, your plan will notify you and you can choose another doctor within the network.
  • If you get health care outside the plan's network, you may have to pay the full cost.

(It's important that you follow the plan's rules, like getting prior

approval for a certain service when needed.)


(Information obtained from 






"Al Crouse & Associates is an independent authorized producer/agency licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (BCBSNC). The content contained in this site is maintained by Al Crouse & Associates. Blue Cross and Blue Shield of
North Carolina is an independent licensee of the Blue Cross and Blue Shield Association." Registered mark of the Blue Cross and Blue Shield Association.  
Copyright 2007 Al Crouse & Associates. North Carolina Web Design by
Memberships and Links:
Boone Weather | Boone NC Vacations | North Carolina Mountain Vacations | North Carolina Golf | North Carolina Ski Resorts