Medicare Advantage HMO plans have been around and are common in the US. According to the Kaiser Family Foundation below are statistics for Medicare Advantage HMO plans:

  • 34% of ALL Medicare beneficiaries (22 million) are enrolled in Medicare Advantage plans as of 2019
  • Out of the 22 million, 62% are in HMO’s with the rest in local or regional PPO’s.
  • 29% of new Medicare beneficiaries enrolled in an Advantage plan during their first year on Medicare.

Medicare Advantage HMOs are popular because of low premiums. Some plans, premiums can be as low as $0. Typically, on an HMO plan you must treat with In-Network providers except in the case of an emergency.

Medicare Advantage HMOs are health maintenance organizations through which Medicare beneficiaries can access their Medicare services. The insurance company contracts with certain doctors and physicians in your local area to form a network. You will select a primary care physician (PCP) who will coordinate your care. Be aware that one main requirements to enroll in their plans is you must first be enrolled in both Medicare Parts A and B. You must also live in the plan’s service area.

What is an HMO?

When you enroll in a Medicare Advantage HMO, you agree to acquire your health care only through the plan’s network, except in emergency situation. Most HMO’s do not have coverage out-of-network. This means that when you use services that are not in network, you may pay the full price for that service.

Some carriers have plans that have an HMO-POS model.  POS stand for Point of Service, and functions like an HMO and PPO plans. In a POS plan, you can use certain providers outside the network in certain situations, such as traveling, at the same in-network cost-sharing amount. Depending on the carrier and their plan, HMO-POS can vary between plans.

  • One Health Question – Medicare Advantage HMO’s only have one health underwriting question. Are you receiving Routine Dialysis for Kidney Failure?
  • Premiums Are Lower than Supplement plans – Some plans have a $0 premium. However, premiums can change from year so it’s important to always review your Annual Notice of Change letter each fall.
  • Pay When You Use the Plan – Pay as you go in the form of co-pays or coinsurance. Each plan has a benefit summary which will tell you how much the provider is allowed to charge for certain services. Co-pays vary for services like doctor’s visits, lab-work, and inpatient hospital care
  • Primary Care Physician – You must select a Primary Care Doctor (PCP) or see if your current doctor is in the network and accepts the plan. Your PCP can coordinate a referral to send you to a specialist when needed. Some insurance companies offer HMO-POS plans. These point-of-service plans may also some out of network services at higher copays.
  • Local Network – you must get your care form local healthcare providers and hospitals, except in emergencies.
  • Prescription Drug Plan – are included in many HMO plans. In most cases, your drug formulary is included in their drug plan.
  • Annual Notice of Change – each year you receive an AOC from the plan, this is also known as the Annual Notice of Change. This letter will tell you the upcoming changes in the Medicare HMO plan for the next year. The premium and/or co-payments, co-insurance, benefits formulary, pharmacy network, provider network, may change on January 1 of each year. Reviewing your plan from year to year is important and a necessary duty.

At Nevada Medicare, we analyze, assess, and review your plans every year so that you are informed of the changes and show you what your options are. This forensic plan analysis and consultation is at No Cost to you. If you need clarifications on how a Medicare Advantage HMO may work for you, Contact Us today.

Medicare Advantage plans are paid by Medicare (Government) to facilitate and administer your medical care. In order for you to keep you Medicare Advantage plan you must must continue enrolled in both Medicare Part A and B. This means you have to continue paying for your Part B premium each month. The money that you pay for Part B goes toward paying the Medicare Advantage company to insure you.

Medicare (Government) itself is not responsible to pay for any of your services once you enroll in a Medicare Advantage plan. Your medical providers will send the bills to your Medicare Advantage company.

Medicare Advantage HMO plan availability varies by county. Nevada Medicare is contracted to work with Aetna HMO, Blue Cross Blue Shield, Coventry, Humana, United Healthcare and several other carriers. We can check plan availability for you in your county.

What’s the Best Plan?

Choosing the right Medicare Advantage plan is on a case to case basis. Be very careful when you select a plan. A plan that is perfect for your friend may not work out for you because your doctor isn’t in the network. Another plan might have great prices for blood pressure medications, but will not work so well for someone who takes a different set of medications. Going over your doctors and prescription medications is the first step in finding out which plans in your area will best fulfill your needs.

Star Rating 

Medicare Advantage plans are rated by Medicare(Government). This rating system is in a Star Rating format. Much of this rating is based on feedback Medicare (Government) receives from current plan members. Five stars is the highest rating. Majority of the plans have 3 and 4 stars. A plan that has a rating lower than 3 is required by Medicare (Government) to notify you and its members. You can change out of that plan mid-year and do not need to wait til the Annual Election Period.

At Nevada Medicare we go through a rigorous assessment and review of each Medicare Advantage HMO plan. Our Medicare licensed agents can breakthrough the ever confusion and errors that happens frequently with Medicare beneficiaries. We know this because we hear it from folks like you everyday. We can provide you important information and go over the Medicare Advantage HMO’s plan star rating and history in Nevada as well.

Most importantly, we can tell you whether your physicians participate in the plan or find a plan that enables you to see your chosen doctor. We can also help you consider factors specific to you, by examining the most efficient plans that have a built-in Part D drug formulary that includes your medications at a lower cost.

Let us do the hard work everyday, while you live and enjoy the more important aspects of your lifetime. Contact Us our help is free.