4 Key Takeaways of Medicare Advantage Health Maintenance Organization (HMO) Plans

While many older adults choose Medicare Advantage as their preferred alternative to Original Medicare, many don’t know that Medicare Advantage offers several different kinds of plans. One of the most popular Medicare Advantage plans is the Health Maintenance Organization (HMO) plan. However, a Medicare Advantage HMO differs from other private HMO plans in several important ways. Let’s take a closer look at the 4 key takeaways of Medicare Advantage Health Maintenance Organization (HMO) plans.

You Still Get Medicare Part A and Part B

If you’re worried that a Medicare Advantage HMO plan will offer less coverage than Original Medicare, then worry no more. Like every Medicare Advantage plan, Medicare Advantage HMOs offer all of the same benefits as Original Medicare. This includes all of the benefits and coverage options of Part A and Part B. Generally speaking, Part A helps with inpatient hospital care, while Part B pays for outpatient care, mental health care, and Durable Medical Equipment (DME).

Most Medicare Advantage HMOs Include Drug Coverage

One of the main reasons that older adults switch to Medicare Advantage is to simplify their healthcare coverage. Rather than getting Original Medicare and a separate Part D plan for prescription drug coverage, you can get a Medicare Advantage HMO plan that includes Part D. However, it’s important to remember that not every HMO plan includes prescription drug coverage — though many do. You will need to consult with your provider before you enroll in a Medicare Advantage HMO plan to determine if it will include Part D coverage.

HMOs Require You to Seek Care Within Your Network

With a Medicare Advantage HMO plan, you have a predetermined network of doctors, hospitals, and clinics that make up your network. When you get treatment within your network, you can expect your healthcare to function as it normally would. However, if you attempt to seek treatment outside of your network, you may not be covered. Even when you do have coverage for out-of-network care, you’ll generally have to pay higher coinsurances or copayments. If you wish to have a Medicare Advantage plan that has similar benefits to an HMO plan but with fewer network restrictions, you’re better off with a Preferred Provider Organization (PPO).

You Need to Choose a Primary Care Provider

Though you can always seek treatment among different physicians within your network, you will be required to choose a primary care physician with a Medicare Advantage HMO plan. This makes it simpler to manage billing processes and gives you benefits when seeking care from your primary physician. However, some older adults prefer a plan that does not require a primary care physician, in which case a PPO plan is the better option.

The Bottom Line

Medicare Advantage HMOs are some of the most cost-effective plans on the market. Though you may face steeper fees or lapses in coverage if you seek care out of your network, in-network care is very affordable. Thus, a Medicare Advantage HMO plan is best for older adults who do not travel much and want a plan that provides prescription drug coverage.

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