Medicare Advantage HMO Plans

Find a Medicare Advantage HMO plan that is right for you!

Medicare Advantage Health Maintenance Organizations (HMOs) are private plans that the federal government pays to administer Medicare benefits. By law, they must provide you with the same or better coverage than Original Medicare (Parts A and B).

In an HMO Medicare Advantage plan, you will usually need to see an in-network provider for services to be covered. The only exceptions to this rule would be emergency services, urgent care out of the area, or dialysis services out the area.

Some HMO plans may have the option to see an out-of-network doctor at a higher out-of-pocket cost. These are called HMO-POS (Point of Service) plans.

If you are wondering if a Medicare Advantage HMO plan is the right choice for you, or if you have specific questions, we would love to help.

Do I have to pick a primary care doctor with an HMO plan?

With most HMO plans, you will have to pick a Primary Care Physician (PCP) during the application process. However, this can be changed at any time by contacting your plan.

Do HMO Medicare Advantage plans require referrals to see a specialist?

In the past, most HMO Medicare Advantage required referrals to see a specialist. However, many carriers are changing that policy. Refer to the Summary of Benefits for each plan to determine if referrals are required.

Do HMO Medicare Advantage plans cover prescription drugs?

Most Medicare Advantage plans are MAPD plans, which do cover prescription drugs.

Plans tailored specifically to Veterans do not typically cover prescriptions drugs, as to not conflict with Veteran’s benefits.

What happens if I see an out-of-network doctor when I am on an HMO Medicare Advantage plan?

Unless the service is an emergency, you will most likely have to pay full cost.