What is a Medicare Advantage HMO?
Medicare Advantage HMO plans do not offer provider flexibility except in medical emergencies.
How does it work
HMO plans cover only in-network providers, physicians, and hospitals, except for emergency medical care or out-of-area emergency care and dialysis. In some cases, you can also use out-of-network providers, but 100 percent yourself. In an HMO plan, you will need to choose a PCP and also receive a referral for specialist visits.
What does it cover?
Like PPO plans, HMO plans cover all the services that Medicare Advantage plans usually cover:
- hospital insurance
- health insurance
- prescription drug coverage
When you search for hospitals or medical services, you will need to choose from the list of in-network providers your HMO plans cover. If you are looking for services outside of your plan’s list of in-network providers, you may have to pay for all of these services. However, in emergencies such as travel, you may be covered depending on the specific terms of your plan.
Average costs
Medicare Advantage HMO plans have the same basic costs as PPO plans, including monthly plan and Part B premiums, deductible items and payments, and money security. As required by law, your HMO plan will have an annual out-of-pocket maximum for the costs you owe.
Other fees
Because HMO plans require you to search for services within the network, you usually don’t have to deal with additional charges unless you decide to use out-of-network providers. In an emergency, you may pay additional costs, but you should check with your plan to see what those fees are.
There are many similarities between Medicare Advantage PPO and HMO plans, such as the costs of premiums, deduction costs, and other plan fees. Most of the differences between the two types of plans are primarily based on the coverage and costs of on-net and off-net services. Below is a comparison chart of what each plan offers in terms of coverage and costs.
| Plan type | In-network providers | non-network providers | PCP required | Expert advice | Standard Advantage Plan costs | Additional costs |
| PPO | Yes | yes, but at a higher cost | No | not necessary | Yes | for non-network services |
| HMO | Yes | no, except in emergencies | Yes | is necessary | Yes | for non-network services |
Whatever type of Medicare Advantage plan structure you choose, always be mindful of the coverage options and costs associated with the particular plan you choose. Because benefit plans are offered by private insurance companies, they may differ in what they can offer you and when they decide to charge you.
