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Is Medicare HMO The Right Choice?

Man Weighing Three ChoicesShould you consider a Medicare HMO?

The Medicare Advantage landscape has changed dramatically in the past couple of years.

Changes have generally been in the form of less choice. Competition, profit motive and regulation have driven some companies to exit many markets.

United Healthcare, WellCare, Coventry and many others have either scaled back or eliminated private fee-for-service plans (PFFS). Many companies have begun to offer mostly Medicare HMO plans.

Medicare HMO plans can be attractive if you can live with the network restrictions. For many Medicare beneficiaries the idea of being held captive by a network is not at all palatable.

People who can live within the network are finding value in Medicare HMO plans. Once you know the facts and compare available plans you will be able to determine if a Medicare HMO is right for you

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More Medicare Advantage plans are HMO

Medicare HMO plans can be popular for several reasons.

  1. Plans have some of the lowest monthly premiums and co-pays.
  2. Many Medicare beneficiaries do not travel or seek medical services out side of their HMO network so the restrictions don’t matter.
  3. Medicare HMO plans are rich in extra benefits such as dental and vision.
  4. Lack of choice may be driving people to consider a HMO as an affordable option.

This last point may have more to it than many people realize. Many Medicare beneficiaries cannot afford Medigap premiums especially when they realize that they must also purchase a stand alone Part D drug plan as well.

Some PFFS Medicare Advantage plans, like Humana Gold Choice, have become nearly as expensive as  Medicare supplements. Also many people have been stung when their health care provider decided not to accept their PFFS plan.

Medicare HMO or PPO

Medicare PPO plans are popular options and afford the member more freedom to receive services out-of-network but they are not readily available in all areas. It may be easier for a medical provider to accept the negotiated rate when they know that they are the only game in town.

A provider that accepts a negotiated rate to enter a PPO arrangement runs the risk of having plan members go out of network even if it costs them a little more. In this case the provider in the PPO network may not add new patients to their practice. The patients in a PPO may be more than willing to pay a little more so they can keep their own doctor.



If you have both PPO plans and HMO plans available you may want to review the Summary of Benefits for each plan to determine if benefits are richer in one plan or the other.

Often a HMO will have lower out-of-pocket costs and richer value added benefits like; dental, vision , hearing and other health and wellness related services and discounts.

Considering Medicare PPO – Read This Before You Enroll

Getting information on a Medicare HMO

It’s no doubt that you will be overwhelmed with plan literature. Take the time to understand the type of plan your are considering and what type of network the plan utilizes.

You can also visit the Medicare website and search for plans in your area. Plans will be listed as either PFFS, PPO, HMO or HMO-POS Medicare plans.

Learn the Pros and Cons of Medicare HMO Plans

5 comments

  1. William. Good question. Many people want to change their Advantage plans prior to the Annual Enrollment Period. Unless you have a special enrollment period, you and your wife may have to wait to the Annual Enrollment Period for 2011. This starts November 15 through December 31. There are several different AARP Medicare Complete Advantage plans and I’m not sure what is available in your area. Here is the phone number for Secure Horizons AARP Medicare Complete: 1-800-547-5514. Give them a call to explain your situation to see if you have a special enrollment period and get your questions answered.

  2. I am interested in knowing what the in-network pharmacies are in my area (Zip Code 54136) and in our winter area location (Zip Code 78516).

  3. I HAVE A WELLCARE VALUE(HMO-POS) (H1112-027), DOES IT HAVE DENTAL COVERAGE? IF IT DOES, WHAT IS THE WAY TO FIND OUT(A PHONE NUMBER TO CALL)?

  4. Malye, Call the member services number on your card.

  5. I am enrolled in United Healthcare Medicare Complete Plan 2 (HMO) and I cannot find a list of providers (and specialists) in the New Haven CT area… ???

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