Medicare HMO Plans

Medicare HMO plans typically offer lower monthly premiums than other plan types. Specifically, this refers to Medicare Advantage plans. Medicare Advantage plans offer benefits for your healthcare through private insurance companies.

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However, lower premiums come with less flexibility. Learn about Medicare Advantage HMO plans and how you may be able to benefit from their coverage below.

Medicare Advantage HMO Plans

Some Medicare Advantage plans are Health Maintenance Organizations (HMOs). Every HMO has a network of doctors providing services to their members. You must choose a primary care doctor within your plan’s network if you have insurance through a Medicare HMO plan. This doctor will coordinate care and provide referrals when necessary to see a specialist.

The doctors in your network will usually be in your local area. If you go to a provider outside the network (other than in an emergency), you’ll have to pay the total cost out-of-pocket.

Many overlook these restrictions since Medicare HMO coverage is usually less expensive than other Medicare Advantage coverage or Medicare Supplement (Medigap) plans in terms of monthly premiums. Some Medicare Advantage HMOs don’t have a monthly premium aside from the standard Medicare Part B premium.

Except for emergencies, you must see Medicare HMO providers in your network. However, some Medicare HMO plans have an additional point of service or POS feature that allows you to go outside the network in certain situations. For example, while you are traveling.

Private insurance companies sell Medicare HMOs. This means each plan will come with a different copay, coinsurance, and provider network. Many plans also include prescription drug coverage.

Medicare HMOs are different from Medicare PPOs. With a Medicare Advantage PPO (Preferred Provider Organization), beneficiaries can use doctors and facilities outside their network, albeit at a higher cost.

A PPO plan usually has higher premiums than a Medicare Advantage HMO plan. Further, unlike a Medicare HMO plan, Medicare Advantage PPO plans do not require a referral to see a specialist in most cases.

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Eligibility for Medicare Advantage HMOs

Anyone with Medicare who lives in an HMO plan’s service area can join the plan, including those with End-Stage Renal Disease (ESRD).

You can join a Medicare Advantage HMO plan when you first become eligible for Medicare during your Initial Enrollment Period. When eligible for Medicare, you can also enroll during the Annual Enrollment Period from October 15 through December 7 each year.

In some situations, you may qualify for a Special Enrollment Period. In this case, a qualifying life event – such as moving or losing your coverage – affords you the opportunity to enroll in a Medicare Advantage plan when you would otherwise be unable.

Is Medicare HMO the Same as Medicare?

Medicare HMO and Medicare are not the same. Medicare itself is a health insurance program provided by the federal government. Medicare HMO plans are a type of Medicare Advantage plan that falls under this program’s umbrella, offered by private insurance carriers.

Medicare Advantage HMO plans are an alternative to Original Medicare (Medicare Part A and Part B). Although all Medicare Advantage plans cover the same services as Medicare, there are some significant differences:

  • Medicare doesn’t have doctor networks
  • Many Medicare Advantage plans include Medicare Part D through a Medicare Advantage Prescription Drug Plan
  • Medicare doesn’t include medicines, but you can buy a Medicare Part D policy to use alongside your Original Medicare coverage

It’s also important to note that if you have a Medigap plan, you cannot enroll in a Medicare Advantage plan at the same time.

How To Find the Right Medicare HMO Plan for You

If you’re looking for the best Medicare coverage, let us do the legwork. We’ll search the top insurance companies in your area and give you a free, no-obligation quote.

For some seniors, Medigap coverage may be a better option than a Medicare Advantage plan. Our agents help you find the best choice for your needs. Call us at the number above to discover the right solution for you.

Unable to call? Fill out our online rate comparison form to get started. Whether it's a Medicare HMO plan, PPO coverage, or Medigap, we are committed to delivering the best solution for your healthcare.

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Kayla Hopkins

  • Content Editor

Kayla Hopkins is an accomplished writer and Medicare enthusiast serving as the Editor of Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.

2 thoughts on “Medicare HMO Plans

    1. Hi Sheldy! The list of providers depends on the carrier you enroll with. There should be information in your summary of benefits that tells you where to find the plan’s directory of doctors in the plan’s network.


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