HMO Plans
MA Health Maintenance Organization Plans
There are different types of Medicare Advantage programs that have unique pros and cons. A Health Maintenance Organization (HMO) is one kind of Medicare Advantage Plan. While it saves money in the short run, it also offers less flexibility. Learn more about HMOs below.
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Basics of an HMO
An HMO organizes providers into in-network and out-of-network. The insurance companies construct an agreement with the in-network providers to provide care to patients for a certain amount. An HMO will only pay for the use of in-network providers. Your out-of-pocket expenses are more manageable if you receive care from these in-network providers. However, if you receive care out-of-network, you’ll likely have to pay most, if not all, of the cost of services.
Advantages and Disadvantages of HMOs
The advantage of an HMO is the affordability. By using only in-network providers, your monthly premium, copay, and coinsurance are lower than other types of plans. However, this affordability comes at the price of flexibility. The major disadvantage of HMOs is the lack of flexibility in choosing providers or networks. Your provider and hospital must be in-network. You are also required to find a primary care physician (PCP) that is in-network.
Additionally, you need a referral from that PCP if you need a specialist. Another disadvantage of an HMO is the need for prior insurance authorization for certain healthcare services. Finally, as stated above, if you receive any care from doctors outside of your network, you may pay the full cost for the services.
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Overall, an HMO is a good option for patients who want to keep monthly costs low and don’t anticipate receiving care outside of their network. To figure out whether an HMO is right for you, call us today at Modern Senior Benefits.
