HMO Plans

WHAT IS A HMO PLAN?

Health Maintenance Organization (HMO) Plans are a type of coverage you can get under Medicare Advantage Plans. These plans offer the benefit of having a lower copays compared to other Medicare Advantage Plans, such as PPO Plans.

HMO’s tend to have less flexibility regarding coverage and where they receive their healthcare. This structure gives beneficiaries lower copays.

PROS OF HAVING AN HMO PLAN

As an HMO plan holder, you will get:
● Every benefit that you would from Original Medicare
● Extra benefits such as hearing, vision, and dental care, which Original Medicare does not cover
● Prescription drug coverage with no need to sign up for Medicare Part D separately
● May offer an annual limit on out-of-pocket expenses. Once paid, you don’t have to pay for any Medicare-covered services for the remainder of the year

CONS OF HAVING AN HMO PLAN

As an HMO plan holder, you will not get the freedom to see any doctor you choose:

● You will likely have to choose a primary care doctor.
● Your primary care doctor’s referral may be required before you can see a specialist.
● Out-of-network care not covered
● Only in emergencies will you be able to receive coverage when receiving care outside of the plan’s network.

WHEN TO ENROLL

If you are eligible for Original Medicare, you are also eligible for a Medicare Advantage Plan. You have to make sure you are enrolling during the proper enrollment periods.

Some of the enrollment periods to take note of are:

Initial Enrollment Period: The Initial Enrollment Period is the seven-month time frame that starts your Medicare eligibility. It begins three months before your 65th birthday and ends three months after.

Annual Enrollment Period: AEP begins on October 15th and ends on December 7th of every year. During this period, you have the option to make changes to your Medicare coverage, such as switching from Original Medicare to Medicare Advantage. In addition, current enrollees in Medicare Advantage can switch to a different Medicare Advantage Plan.

Special Enrollment Period (SEP): The SEP can be triggered in several ways but is ultimately unique to the individual’s situation. It is best to speak with one of our Medicare Specialists to determine if you qualify for a SEP. One of the most common reasons beneficiaries qualify for this period is because they moved out of their plan’s service area. If you are eligible for this period, you have the option to make changes to your Medicare Advantage Plan, or you switch back to Original Medicare.

To learn more and get your questions answered about Medicare Advantage and HMO Plans, reach out to one of our Medicare Specialists today!