Medicare itself is not an HMO or PPO or any other type of network. Original Medicare which is now how Medicare is typically referred to is either accepted or not by a doctor. By accepting Medicare the doctor is agreeing to accept what Medicare pays for a certain procedure/visit. The doctor also can agree to accept Medicare Assignment or not which is a whole different topic.
What Are Medicare HMO Plans?
Medicare HMO plans are going to be Medicare Advantage Plans or Medicare Part C plans. These plans are completely different than Original Medicare. When you join a Medicare HMO plan you do have to be aware of the network of physicians and facilities that the HMO plan is contracted with. If you see a provider outside of the HMO network, the HMO insurance will not pay the bill. With Medicare HMO plans you must remain in the network at all times with the exception of emergency and urgent care when traveling. Medicare HMO plans also require a referral in most cases to see a specialist. There are a few exceptions to this rule, but not many. Finally, these plans also usually require authorizations for most procedures and expensive name brand drugs. On the positive side, you will find that you will typically save money on premium and co-pays when you are in a Medicare HMO plan which is why many Medicare beneficiaries find them so attractive.
Is a Medicare HMO Plan Right For You
Everyone has different needs and wants when it comes to health coverage. The first thing you must look at is how attached you are to your doctor. If you have a primary care doctor that you will absolutely not leave then you have to make sure that doctor is in the HMO’s network. If you see several specialist the same thing applies. Also, consider how willing you are to deal with the HMO requiring the referral and the authorizations. Take into consideration that most specialist are going to require the referral even if the insurance does not.
And finally, consider the cost. Many times the HMO is going to be considerably cheaper for the more expensive procedures. Hospital stays, MRI’s, and outpatient surgery are some typical areas where you can save substantially with an HMO. Also, know that not all HMO’s are created equally. Some HMO’s offer better networks than others as well as making faster payments to the doctors. Some examples of companies offering HMO’s are Humana, United Healthcare, Wellcare, and Healthspring.
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