Pros And Cons Of Medicare HMO Plans

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When it’s time to choose a Medicare plan you have several options available. You can stay with original Medicare, buy a Medicare supplement or enroll in a Medicare Advantage plan. One type of Medicare Advantage plan that gets a lot of attention is a Medicare HMO.

Before you sign on the dotted line it’s good to know a little bit about the pros and cons. Everyone’s circumstances and needs are different but there are features of a Medicare HMO that many people may consider to be beneficial or detrimental.

Because everyone’s situation is unique, some pros and cons may have less of an impact on whether or not this type of Medicare Advantage plan is right for you.

Medicare Advantage plans in general

A Medicare HMO is not your only choice when considering a Medicare Advantage plan.

Plan types include:

  • HMO – Health Maintenance Organization
  • PPO – Preferred Provider Organization
  • HMO-POS – Health Maintenance Organization
  • PFFS – Private Fee-For-Service

Certain rules will govern how all these plans work and when you can enroll, drop or switch plans. But there are significant differences in how you can use your plan.

One misconception about Medicare Advantage plans is that they are Medicare supplements. This is not the case.

With an Advantage plan you receive your Medicare benefits from a private insurance company approved by CMS. A supplement is a separate insurance policy that pays your share of expenses for covered services.

Medicare HMO pros

  • Very little medical underwriting is required. If you are enrolled in Parts A and B, live in the plan’s service area and do not have end-stage renal disease, you qualify.
  • Compared to other types of Advantage plans, premiums and out-of-pocket costs are often lower.
  • Part D is generally included.
  • Medicare HMO’s often include provisions for coordinated care which can make using your plan easier.

Medicare HMO cons

  • Plan benefits, premiums and provider network can change annually.
  • As with all types of Medicare Advantage plans, the possibility that your plan will not renew for thew following calendar year is a possibility.
  • Plan network can limit your treatment options. Most qualified providers and highly rated treatment centers may not be in network.

Another consideration related to HMO’s is whether or not you actually have any to choose from. Insurance companies that offer Medicare Advantage plans can make them available County-by-County.

The nature of how a HMO works for both providers and members makes it more likely that they are less likely to be available in more rural or less populated Counties.

To find out about your Medicare Advantage options visit the official Medicare website and search for plans based on your residential zip code.

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