Plans are required to cover the full range of Medicare benefits that enrollees would receive under traditional Medicare. Additional benefits may also be offered. Health plans are required to accept qualified beneficiaries in their service area and charge a uniform premium and cost sharing. An organization can offer more than one plan in the same area. Premium and cost sharing may vary among different types of plans within the same organization.
Some rules vary depending on the type of plan.
Back to top. Seniors can seek care outside the HMO network at a higher cost. Preferred provider organizations. Beneficiaries can obtain care from a provider network or seek outside care and still have a percentage of their medical expenses paid. Networks of doctors and hospitals will directly take on financial risk.