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?