HMO Plans

Medicare Advantage HMO plans, like other HMO plans, feature a network of healthcare providers, doctors, and hospitals. 

In most cases, you will have to choose a primary care physician and this doctor will be the one who will have to give you a referral to see a specialist.

In urgent and emergency situations, you can receive coverage outside of the plan’s network. Otherwise, you will pay out of pocket for treatment for out-of-network treatment. 

Since they have a network of providers, you can expect an HMO Medicare Advantage plan to have a cheaper monthly premium than a PPO version.

Benefits of Medicare Advantage HMO plans

MA plans offer the same benefits of Parts A and B along with some additional benefits. Your additional benefits may include: 

  • Adult day-care services
  • Dental
  • Fitness memberships
  • Hearing
  • Nutrition programs
  • Prescription drug coverage
  • Over-the-counter drugs
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits
  • Vision
  • Wellness programs

If you have a chronic health condition, you may also receive additional benefits specific to your situation. These could include things like meal delivery, home cleaning, education programs for your disease, visits to a nutritionist, or transportation to grocery stores.

What’s the difference between HMO and PPO?

Medicare Advantage plans come in two varieties: HMO and PPO. 

Both have a network of providers. However, PPOs allow you to see doctors outside of the network. However, it may cost you more in coinsurance. 

HMOs require you to choose a primary care provider and get referrals from them to see a specialist. PPOs do not require these things. 

However, HMOs have a cheaper premium.

How to enroll

If you’re eligible for Original Medicare, you’re eligible for an Advantage plan. 

You can enroll during your initial enrollment period (when you can initially enroll in Medicare). This is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65.

There is also the annual election period that spans from October 15 through December 7 every year. 

Finally, you may be eligible for a special election period if there have been significant changes in your coverage or income. 

You can find out if you are eligible by speaking with a licensed Medicare agent, but here are some instances where you would be eligible: 

  • You move outside your current plan’s area
  • Suffered unintentional loss of coverage
  • Got married
  • Had a baby

There are many more ways you can become eligible for a special election period. So, again, be sure to ask an insurance agent.

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