Each HMO has a network of providers to choose from. For seniors with Medicare, choosing an HMO can provide significant cost savings, as well as benefits, such as prescription drug coverage, that are not provided by the traditional Medicare plan. Seniors may go outside of the plan, but will pay a larger percentage of the cost or the entirety of the cost. Managed care plans can decide once a year to change coverage, change premiums, or discontinue offering service to Medicare beneficiaries. Beneficiaries can return to the original Medicare program at any time.
Complete coverage is only available in a specified area.
Seniors who travel frequently or have more than one residence may have to pay more for care received outside of the HMO s coverage area. There are lower out of pocket costs and less claims paperwork with HMO plans. Patients generally receive coverage for specialist care after receiving a referral from their primary doctor with HMO plans. If more than one organization offers these plans in your area, compare premiums and other out of pocket costs, as well as the benefits each plan offers. Make sure to ask questions about any portions of your HMO policy that are unclear.