Health Maintenance Organizations (HMOs)
What's an HMO?
An HMO is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. When you have an HMO, you generally must get your care and services from doctors, other health care providers, and hospitals in the plan's network, except:
- Emergency care
- Out-of-area urgent care
- Temporary out-of-area dialysis
Some HMOs are Point-of-Service (HMOPOS) plans that may allow you to get some services out-of-network for a higher copayment or coinsurance . It’s important that you follow the plan’s rules, like getting prior approval for a certain service when the plan requires it.
Questions you may have about HMOs:
|Do these plans charge a monthly premium ?||Yes. These plans usually charge a premium, in addition to the monthly Part B (Medical Insurance) premium.|
|Do these plans offer Medicare drug coverage (Part D) ?||
Usually. Prescription drugs are covered in most HMOs. Check with the plan you’re interested in.
|Can I use any doctor or hospital that accepts Medicare for covered services?||
Sometimes. You generally must get your care and services from doctors, other health care providers, and hospitals in the plan’s network (except for emergency, urgent care, or out-of-area dialysis).In an HMOPOS plan, you may be able to get some services out of network for a higher copayment or coinsurance.
|Do I need to choose a primary care doctor ?||Usually. In most HMOs you need to choose a primary care doctor.|
|Do I have to get a referral to see a specialist?||Yes. In most cases, you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don't require a referral.|
|What else do I need to know?||