Health Maintenance Organization (HMO) plans help to coordinate your medical services to lower your out-of-pocket costs. It is one of 4 Medicare Advantage plans for you to choose from, offering some of the lowest costs. Let’s take a closer look at this option and what it has to offer
How HMO Plans Work
HMO plans rely on an established network of healthcare providers. Compared to other plans, HMO plans have a relatively low cost. Receiving care outside of the network will be more expensive, but your out-of-pocket costs are limited if you need emergency care.
To achieve its low cost, HMO plans have slightly less flexibility than other Advantage plans. For instance, you must choose a primary care physician and receive all medical care through them. If you want to see a specialist, for example, you must first get permission from your primary care physician. It still, however, offers plenty of great benefits, including:
- Prescription drug coverage (in most cases)
- Personally-chosen primary care physicians
- Professional specialist referrals
- Emergencies, out-of-area urgent care, and out-of-area dialysis
- No referrals required for services
HMO Vs. PPO Plans
How can you choose whether or not an HMO or a PPO plan is right for you?
PPO plans will charge less for in-network care while still offering coverage for out-of-network care. HMO plans, on the other hand, charge more for out-of-network care than PPO plans. However, its out-of-pocket costs for in-network care and monthly premium are much lower than PPO plans. It is up to you, then, whether or not you want to pay a bit more for more flexibility.
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