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Medicare Advantage HMO Plans

HMO Meidcare Advantage Plans are offerd by private insurance companies. HMO stands for Health Maintenance Organization.

With Health Maintenance Organization plans, there is a defined network of doctors, clinics, and hospitals. They want you to choose a primary care doctor that will be in charge of sending referrals to see a specialist.

You are able to go to any clinic or ER in the event of a medical emergency or urgent medical need.

Most HMO clients appreicate the extremely low monthly cost and additional benefits these plans offer, above what Original Medicare offers.

What are the benefits of a Medicare Advantage HMO Plan?

If you have looked into an Advantage plan (also known as a Part C plan), you probably know it offers extra benefits Original Medicare doesn’t with little to no additional premium. 

Such benefits can include: 

  • Adult day-care services
  • Dental
  • Fitness memberships
  • Hearing
  • Nutrition programs
  • Over-the-counter drugs
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits
  • Vision
  • Wellness programs

Benefits you are eligible for will depend on your area and plan providers. 

Also, most HMO Advantage plans include prescription drug coverage. But, again, be sure to check with a licensed Medicare insurance specialist to see what benefits are available in your area.

When can I enroll in Medicare Advantage?

There are specific times in which you can enroll in a Part C plan:

Initial coverage election period — Your initial coverage election period is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If that is how you are becoming eligible for Medicare, you can enroll into an Advantage plan three months before your month of eligibility until three months after you became eligible. 

Annual election period — Also known as open enrollment or AEP, the annual election period for Medicare Advantage is October 15 through December 7 every year. Coverage for the Part C plan you choose during this time will begin January 1 the next year. During this time, you can also add, change, or drop current coverage.

Medicare Advantage Open Enrollment Period — During this open enrollment period, you are able to change from one Advantage plan to another or drop it to return to Original Medicare.

Special Election Period — There are several things that can trigger a special election period and they are unique to an individual. It is best to speak to a licensed Medicare insurance agent to find out if you qualify for a special election period. However, there are a few common instances we can talk about. Such as, if you move outside your Medicare Advantage plan’s service area, qualify for extra help (such as a program that helps pay for your prescription drugs), or move into a nursing home you might qualify for a special election period. During this time you can make changes to your Advantage plan or return back to Original Medicare.

What’s the difference between HMO and PPO Medicare Advantage plans?

Medicare Advantage HMO and PPO have more similarities than differences.

The key difference between HMO and PPO: 

  • PPO plans allow you to see doctors outside of the network. The trade off is you may have larger co-pays or co-insurance
  • A PPO doesn’t require you to use a primary care doctor
  • A HMO requires a referral to see a specialist but a PPO doesn’t
  • PPO plans have higher premiums because of their flexibility

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