Medicare itself is not an HMO or PPO or any other network. Original Medicare, which is now Medicare, is usually called either accepted or not by a doctor. By accepting Medicare, the doctor agrees to accept what Medicare is paying for a specific procedure / visit. The doctor may also agree to accept Medicare Assignment or not, which is a completely different topic.
What are HMO Medicare plans?
Medicare HMO Plans are Medicare Advantage Plans or Medicare Part C. These plans are completely different from the original Medicare. When you join a MedMare HMO plan, you need to know about the network of doctors and facilities with which the HMO has been contracted. If you see a provider outside the HMO network, HMO insurance will not pay the bill. With Medicare HMO plans, you should stay online all the time, with the exception of emergency and emergency care when traveling. Medicare HMOs also require referrals in most cases to see a specialist. There are a few exceptions to this rule, but not many. Finally, these plans also typically require authorization for most procedures and expensive drugs with names. On the positive side, you will find that, as a rule, you will save money on premiums and co-payments when you are in the Medicare HMO plan, so many Medicare beneficiaries find them so attractive.
Is a Medicare HMO right for you?
Everyone has different needs and requirements when it comes to medical insurance. The first thing you should pay attention to is how you are attached to your doctor. If you have a primary care doctor that you absolutely do not need, you need to make sure that the doctor is on the HMO network. If you see several specialists, the same thing. Also, think about how ready you are to deal with an HMO that requires referral and authorization. Bear in mind that most specialists will require a referral, even if it is not insurance.
And finally, consider the cost. Many times a HMO will be considered cheaper for more expensive procedures. Hospital sites, MRI and outpatient surgery are some typical areas where you can substantially save a HMO. Also, be aware that not all HMOs are created in the same way. Some HMOs offer better networks than others, and also accelerate payments to doctors. Some examples of companies offering HMOs are Humana, United Healthcare, Wellcare and Healthspring.
