HMO Plans

Basics of Medicare Advantage Plans

Medicare Advantage Plans are alternatives to Original Medicare. There are multiple Medicare Advantage Plans, one of the most common plans being Health Maintenance Organization (HMO) plans. Take a look below to learn more about HMOs.

Basics of an HMO

An HMO is a type of insurance plan that emphasizes low cost at the expense of flexibility. It is not specific to Medicare. Many different insurance models use the HMO model. An HMO works like this: insurance companies make agreements with preferred providers and designates them as in-network providers. These preferred providers will provide your care at a low, flat rate. Unlike a PPO, with an HMO, you cannot receive care outside of your network and still be covered. If you do receive care outside of your network, you will be responsible for the costs.

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Pros and Cons of HMO Plans

The major advantage of an HMO is the cost. HMO plans are some of the most cost affordable plan types. Copays, coinsurance, and monthly premiums are very low in HMO plans. However, these savings are at the expense of flexibility. In an HMO, your provider and hospital must be in-network. You must also find an in-network primary care physician (PCP) and, if you require a specialist, your PCP must give you a referral. Having a strict in-network vs. out-of-network system can save money in the short term, but it can also cost you a lot of money in the long run. If you need any care, like during travel or emergencies, outside of your network, you must pay extra.

It can be tricky to know which Medicare Advantage Plan is right for you. For all of your Medicare questions and concerns, feel free to contact us at Proinsurance Hawaii today.