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What is a Health Maintenance Organization (HMO) Medicare Advantage Plan?

By Kyle Kirkland
Medicare Advantage Plans come in different forms. A Health Maintenance Organization (HMO) Medicare Advantage Plan may be the right option for you.

There are five types of Medicare Advantage plans, according to the official U.S. government website for Medicare. Each type follows a specific coverage model, and you'll likely find that certain models work better for your medical needs and expenses than others. Health Maintenance Organization (HMO) plans are one of the five types of Medicare Advantage plans. Here’s what you need to know about this type of coverage. 

Medicare Advantage HMO Plans

A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage Plan that provides health care coverage from doctors, other health care providers, or hospitals in the plan’s network for certain services.

An HMO plan does not cover emergency care, out-of-area urgent care, or out-of-area dialysis, according to the official U.S. government website for Medicare.

“HMO plans only offer coverage with set provider networks. Generally, these networks are local,” Alice Stevens, Insurance Expert and Senior Editor at Best Company, tells WebMD Connect to Care.

Some features of an HMO plan include:

  • A small network of providers to choose from
  • Less paperwork than other types of insurance plans
  • Required referrals from your primary care physician in order to see a specialist

One benefit of a Medicare Advantage HMO plan is simplicity—you only have to manage one plan instead of many.

“It can be convenient to have one plan to reference and manage, which a Medicare Advantage HMO Plan makes possible, instead of Original Medicare, where you can end up working with up to four different health plans at once,” Stevens says.

In addition to controlling how much you have to worry about, a Medicare Advantage HMO plan also controls how much of your own money you have to spend. This is known as an “out-of-pocket” expense.

Original Medicare (Parts A and B) has no out-of-pocket maximum, which means you may end up spending a significant amount of your own money on your healthcare. All Medicare Advantage plans, including HMO plans, have out-of-pocket maximums. This means that you'll only spend a certain amount of your own money before the insurance covers the rest.

While healthcare coverage is an important factor in deciding insurance plans, there are also some perks that come with a Medicare Advantage HMO plan for you to consider.

“It's common to find fitness-related perks, meal delivery after a hospitalization, some dental coverage, and even discounts or coverage for hearing aids,” Stevens says.

There is a lot to consider when deciding between healthcare plans, but unfortunately, you don’t have long to choose. There are important deadlines to keep in mind if you are interested in enrolling in a Medicare Advantage plan, so make sure you're aware of the timeline while examining your options.

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Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.