Understanding HMO Plans

All HMO Advantage Plans fall under the larger definition of Medicare Advantage Health Plans.

HMO Plans are managed health care plans that are run by private insurance companies. Medicare HMO Plans are actually an alternative to Original Medicare. Private companies provide care to the Medicare participants and then the Federal Government reimburses them. To qualify for an HMO Plan an individual must be eligible for or have Part A and Part B under Original Medicare.

HMO Plan Organizations and Restrictions

Each HMO Plan must adhere to the basic guidelines of care set forth by Medicare. HMO coverage must be substantially similar to the coverage offered by Part A and Part B of Original Medicare. However, beyond these basic guidelines the rules and regulations of HMO Plans are all unique. On the one hand this is advantageous because a person is able to research and find exactly the right plan for their needs. On the other hand, the unique characteristics of each plan make it difficult to compare plans and choose the best plan.

Restrictions in HMO Medicare Plans are something to pay attention to. Carefully examine the provider list to determine if your current doctors are included in the plan. Also be aware that most HMO plans will require you to get a referral from your primary care physician before you will be able to see a specialist. Is this a restriction you can live with? In addition, most HMO plans are location specific. Do you commonly live in a different location for long periods of time? Do you leave town to get out of the snow or to visit grandchildren? These are all good questions to ask yourself when looking into signing up for an HMO Plan.

HMO Network Advantages

The number one advantage of an HMO is that these plans are generally cheaper than Medicare A and B. In addition, these plans are all bundled together so there are fewer things to keep track of. A HMO Network is also very efficient. The doctors and providers are familiar with one another and this can be considerably helpful if you have a complicated medical issue. The Plan Network also insures that unnecessary treatment is less likely to occur. HMO plans also often cover extras that are excluded in Original Medicare. Commonly some dental and vision care is offered and often wellness care and gym discounts are optional. Many Plans also include prescription drug coverage.

HMO Claims Processing and Plan Review

Depending on the HMO Company, the mountains of complicated Medicare paperwork may be somewhat diminished. The Network streamlines billing and makes it easier to keep track of what has been paid and what you owe out-of-pocket. Because you are not allowed to use a supplemental plan with a Medicare HMO Plan the endless confusion about who pays first is a non-issue. Moreover, most insurance companies will assign you a capable insurance agent. It's this person's job to keep you as a customer and keep you happy. A good insurance agent is worth their weight in gold. If you have a billing problem, they can often fix it. If there are changes in Medicare's rules, they will know the changes and can explain them to you. When you are shopping for an HMO Plan, make sure to take into consideration helpful and capable agents.