A Medicare Advantage Health Maintenance Organization (HMO) plan is a Medicare approved health plan that provides you with access to a network of doctors and hospitals that coordinate your care, with an emphasis on prevention.
A Health Maintenance Organization should
allow you to get more benefits than the Original Medicare plan (Medicare Part A and Medicare Part B) and many Medicare Supplement plans.
PLEASE NOTE: An HMO may include prescription drug coverage and is called an MAPD. If an HMO DOES NOT include prescription drug coverage (called an MA), you may not be able to join a stand-alone Medicare Part D Prescription Drug plan. Enrolling in a Medicare Part D plan when you have an HMO may automatically dis-enroll you from your HMO Medicare Advantage plan. When in doubt, please contact your Medicare Advantage plan.
An HMO has the most restrictive network where your care may not be covered if you go outside the HMO network without obtaining prior approval.
If I join an HMO...
Can I get my health care from any doctor, other health care provider, or hospital?
You generally must get your care and services from doctors, other health care providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some plans, you may be able to go out-of-network for certain services, usually for a higher cost. This type of plan is called an HMO with a point-of-service (HMO-POS
Are prescription drugs covered?
In most cases, yes. If you want Medicare drug coverage, you must
join an HMO plan that offers prescription drug coverage (MAPD).
Do I need to choose a primary care doctor?
In most cases, yes.
Do I have to get a referral to see a specialist?
In most cases, yes. Certain services, like yearly screening mammograms, don't require a referral.
What else do I need to know about this type of plan?
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- If your doctor or other health care provider leaves the plan's network, your plan will notify you. You many choose another doctor in the plan's network.
- If you get health care outside the plan's network, you may have to pay the full cost.
- It is important that you follow the plan's rules, like getting prior approval for a certain service when needed.
- If you need more information than listed here, check with the plan. You can find the plan's member services telephone number by clicking on the "benefits & contact info" button on our MA-Finder.com.
about Medicare Advantage Plans.