There are two main kinds of Medicare Advantage plans: Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs).
HMOs are a type of managed-care plan offered by private insurance companies. HMOs typically have lower out-of-pocket costs if you get your care from healthcare providers within the plan’s preferred network of doctors.
An HMO covers all the benefits of Original Medicare (Part A and Part B), and extras, all in one plan, for generally less than you would pay out-of-pocket for Original Medicare, Medicare Supplement or Medicare Advantage PPO plans. And, it puts a maximum on how much you will pay out-of-pocket every year.
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Some things to keep in mind with a Medicare Advantage HMO
- Most have $0 monthly premiums, depending on your area. All you will pay is the standard Part B premium, since Part B is packaged in the plan.
- Monthly premiums do not increase based on age.
- To keep costs down, you’ll need to get care from healthcare providers within the plan’s network, except in emergencies.
- Some require you to see a PCP who will coordinate, communicate, and direct all of your care with specialists.
- Some do not require referrals to see specialists who are in the preferred network.
- Healthcare providers may refer individuals to specialists who are not in-network at in-network rates in certain circumstances.
- Some, not all, HMOs have smaller networks of providers who are selected to participate in the network.
- Most encourage preventive healthcare to help keep you healthy by covering entire costs or offering low copays.
- Some offer access to doctors who are held responsible and paid to help keep you healthy by using proven national standards that encourage medical teams (primary care doctors and specialists) to work and communicate with each other to coordinate your care. Also, you will not pay extra for more PCP visits; it’s all part of staying on top of your health to keep you healthy.
Did you know? The rate of potentially avoidable hospitalizations in Medicare Advantage beneficiaries is 43% lower than Original Medicare beneficiaries.
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