Medicare Advantage plans are available in both PPO and HMO options. These Medicare Part C plans require you to get your healthcare services from in-network providers unless it’s an emergency, or you are out of the area and need urgent care or urgent dialysis. Some plans allow you to go outside of the network, but you’ll save more money if you see doctors within it. In most cases, you risk your coverage and owing the full amount of services if you see a doctor outside of the network.
How Medicare Advantage HMO Plans Work
With a Medicare Part C HMO plan, you must choose a primary doctor. This is the doctor you must see before you seek any other medical attention. Think of your primary doctor as your ‘medical home.’ You see your primary doctor first. If this doctor thinks you need to see a specialist, he/she will provide you a referral. This referral is necessary if you want your HMO plan to cover the visit.
Your HMO plan may include a variety of services that Medicare Part A and Part B don’t offer.
This may include:
- Dental care
- Vision care
- Hearing care
- Prescription coverage
- Health/wellness benefits
Keep in mind if you want prescription coverage, you can enroll in either a stand-alone prescription drug plan or a Medicare Advantage plan with prescription drug coverage built in. You cannot have a Medicare Advantage plan with drug coverage built in and a separate stand-alone drug plan at the same time, you must choose either or.
It’s important to know that if your doctor leaves the HMO plan, you must pick a new primary physician. Your HMO plan will notify you of the doctor leaving the plan, and then it’s up to you to choose another doctor.
Get Free Medicare Help
- Compare Costs of Plans
- Estimate Your Savings
- Help You With Enrollment
What Are the Differences Between Medicare Advantage PPO and HMO?
You have two options when choosing a Medicare Advantage Plan – PPO or HMO. While they are both Medicare Part C plans, there are vast differences:
- PPO plans don’t require you to choose a primary doctor. You can see any doctor within the network, including specialists
- PPO plans allow you to see any doctor, even those outside of the network, but you’ll pay higher co-pays. HMO plans pay nothing outside of the network.
- PPO plans have higher premiums.
- PPO plans don’t require a referral to see a specialist, but HMO plans do.
HMO plans are more restrictive, but they cost less. If you are okay with choosing one doctor for most of your needs and securing a referral before seeing a specialist, you may enjoy the benefits and lower cost of the Medicare Advantage HMO plan.
Contact Senior Insurance Representatives Today
Are you trying to figure out which of the Medicare Advantage plans suit your needs? Are you choosing between a PPO and HMO plan, but don’t know which is right? Let the specialists at Senior Insurance Representatives help you decide. Call us today at 1-800-327-7888.
