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August 9, 2010

Medicare Advantage HMO Plans

What is an HMO Plan?

The word "HMO" means "Health Maintenance Organization." A Medicare Advantage plan that provides its benefits through an HMO uses a network of providers to deliver the plan's health care services to people enrolled in the plan.

As a member of an HMO, you will be required to choose a primary care physician ("PCP") within the network who will provide most of your health care and refer you to HMO specialists as needed. Health care services obtained outside of the HMO are typically not covered, though there may be exceptions in case of an emergency.

Questions to Ask Before Joining an HMO Plan

Since an HMO requires you to use health care providers within its network, alongside your evaluation of plan coverage, you should also ask the following questions before enrolling in an HMO:

  • Is my current doctor within the HMO's network of health care providers?
  • Are the health care facilities belonging to the HMO network located near me?
  • Are there any customer satisfaction surveys for the HMO I can review?

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Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare and provide Medicare Part A and Part B coverage. Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the "gaps" in original Medicare coverage.