Medicare Advantage plans come in a number of different formats, such as Preferred Provider Organization plans and Health Maintenance Organization plans. Each plan offers mostly the same benefits, but the way these benefits are configured and the rules of each policy differs slightly across plan types. Here is what you need to know about Health Maintenance Organization plans.

What Are Medicare Advantage Plans?

Medicare Advantage are privately administered Medicare insurance plans that offer members the same benefits as Original Medicare. These plans may offer supplemental benefits, such as transportation assistance or meal delivery as well. Different plans are available depending on your region, health care status, or other specialized criteria.

What Is A Health Maintenance Organization Plan?

A Health Maintenance Organization (HMO) plan allows you to receive assistance paying for health care services rendered by a network of approved health care providers. With an HMO plan, you may be able to receive coverage for out-of-network treatment, but it will cost significantly more. Though, you generally must get your care from providers within the plans network unless you are receiving emergency care, out-of-area urgent care, or out-of-area dialysis.

HMO Plan Rules

HMO plans have a few unique rules. First, HMO plans require members to choose a primary care doctor. They also need a referral to see specialist health care providers. Though, some services, like yearly mammograms administered by a specialist typically don’t require a referral. In some cases, you may need to get prior approval for a service, or you may be held accountable for the full cost of the treatment. Be sure to read the rules of your policy thoroughly so that you are fully aware of your plan’s limitations.

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