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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 ehealthmedicare.com) 




 
   
 


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