HMO stands for Health Maintenance Organization. An HMO is a Medicare Advantage plan that gives you quick, easy, direct access to a robust network of doctors, medical personnel and facilities. As a member of an HMO, you are required to choose a Primary Care Physician (PCP) who is responsible for coordinating all your health care needs. We offer many fine HMO plans for you to choose from.

How does a HMO plan work?

If you should need medical care, you simply visit your Primary Care Physician. If you receive hospital care, or other health care services without your PCP’s referral, neither your HMO nor Medicare will pay for the service. The only exceptions are for emergency and urgently needed care, out-of-area renal dialysis, and services where you may self-refer.

What are the advantages of an HMO plan?

The main advantage of the HMO is the lower annual premium. Another advantage is the preventive programs for members that can help educate and guide you about ways to live a healthier lifestyle. However, keep in mind that with an HMO referrals to specialists are limited. And if you will need to see a specialist outside the network it can be expensive.

What are the costs?

Each time you visit your Primary Care Physician, or have a medical service done, you’ll be asked to pay a small, out of pocket co-pay. You’ll also have a yearly deductible to pay before your insurance provider will begin paying for your medical fees. Should you want to see an out-of-network doctor you may certainly do so. Keep in mind, however that the deductible will probably be higher and you’ll probably be asked to pay a larger part of the medical bill.

Who should choose an HMO plan?

If you have no unusual or serious medical conditions, if you think you will only need routine care and not require specialists outside the network, then an HMO plan is an excellent choice.

Who is eligible?

You are eligible for an HMO plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with end-stage Renal Disease are generally not eligible to enroll in an HMO plan unless they are members of our organization and have been since their dialysis began.