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Medicare HMO – Provider Network Is Key

A brief look at the pros and cons of a Medicare HMOThumbs Up and Thumbs Down

As the premiums for Medicare Supplement plans continue to rise many Medicare beneficiaries are turning to Medicare Advantage plans.

One popular type of plan is a Medicare HMO Advantage plan. People looking to to lower their health care premiums may bristle at the perceived lack of freedom with a Medicare HMO Advantage plan.

A HMO plan requires you to have a primary care physician that coordinates your care and typically refers you to HMO network specialists and facilities to receive your care.

On the surface this seems like less freedom of choice. But even those people who have original Medicare or original Medicare and a Medicare Supplement choose a primary care physician and generally accept their recommendations as it relates to care with a specialist or health care facility.

Whether or not less choice is a factor depends more on how comprehensive the HMO provider network is than whether you can choose from all providers that accept Medicare assignment or only the ones in the HMO network.

So the network for a Medicare HMO Advantage plan can be either a blessing or a curse. It all depends on whether you feel you will have enough choice in network.

Benefits of a Medicare HMO Advantage Plan

The main benefit for most people, and the one that draws them to a HMO plan, is the low monthly premium or in some cases no monthly premium. This benefit is coupled with the fact that unlike a Medicare Supplement you will have cost sharing in the form of deductibles, co-pays and co-insurance.

The good news is that the co-pays for many services are affordable for most people. In fact, cost sharing for a Medicare HMO Advantage plan is often less than for a Medicare PPO or private fee-for-service Medicare Advantage plan.

Another benefit is that all providers in the network will accept your plan. One big disadvantage of a private fee-for-service plan is that providers can accept your plan on a visit by visit basis. It’s nice to save money on premiums but it’s more important that you have coverage when you need it.

A Medicare HMO Advantage plan is often rich in benefits that go beyond what original Medicare provides. Many HMO plans include generous vision, dental and hearing benefits. Some plans include discounts on medical related supplies and supplements. Gym memberships are also a popular addition to Medicare HMO Advantage plans.

In the end you need to weigh the savings in monthly premium against your potential for some out-of-pocket cost sharing. One feature of an Advantage plan that ads some peace of mind is that typically you have a maximum calendar year out-of-pocket amountt that you would be responsible for. This feature will limit your liability when it comes to your share of the cost.


Choosing a plan

It’s best to do your homework. Check out the official Medicare website to compare plans in your area. Go to the plan website and search for the provider directory in your area to see if the HMO network will meet your needs.

If saving some money by lowering your monthly premiums is your goal you may find a Medicare HMO Advantage plan to be a viable option.

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