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Medicare Advantage HMO Plans

Senior Benefit Solutions; Medicare Advantage HMO Plans

There are several types of Medicare Advantage Plans. Private insurance companies offer HMO (Health Maintenance Organization) plans.

HMO plans require their members to receive care from a provider that is in their HMO network. Going out(Some coverage is offered in the case of emergency services.) going the HMO network means that the plan will offer no coverage, and the member will be responsible for all expenses. (Some cos also require their members to choose a Primary Care Physician (PCP) and receive a referral from them to see a specialist.

Though they do come with some restrictions, HMO plans also offer lower monthly premiums.

What are the benefits of a Medicare Advantage HMO Plan?

Medicare Advantage plans offer additional benefits not covered in Original Medicare. These additional benefits apply to Medicare Advantage HMO plans.

  • dental care
  • hearing exams
  • hearing aids
  • vision exams
  • glasses or contact lenses
  • gym memberships
  • wellness and nutrition programs
  • over-the-counter drugs
  • prescription drugs
  • adult daycare
  • transportation to doctor visits
  • services for chronic conditions

The specific benefits and coverage levels for services like these will vary by plan.

Many Medicare Advantage plans offer prescription drug coverage, but you’ll need to check to make sure the plan you choose also has this coverage.

The wording Medicare Advantages wrote out on a notebook referring to an HMO Plans.
Many Medicare Advantage plans offer prescription drug coverage.

When can I enroll in Medicare Advantage?

Once you are enrolled in both Medicare Parts A and B, you can also enroll in a Medicare Advantage plan. There are specific enrollment periods that apply to Medicare Advantage plans.

Initial Election Period

Each individual has their own Initial Election Period. This period begins 3 months prior to your 65th birthday and extends 3 months after your 65th birthday, for a total period of seven months.

If you are receiving disability benefits from Social Security, you are eligible for Medicare after receiving disability benefits for 24 months. You may apply for an MA plan three months prior to your eligibility date (which would begin on the 25th month of your disability benefits). This enrollment period extends to three months after your eligibility date.

Special Election Period

To qualify for a Special Election Period, you must meet certain requirements. The most common way individuals qualify is if they postpone enrollment into Original Medicare because they have other creditable insurance coverage. Once the individual enrolls in Original Medicare, they are also eligible to enroll in Medicare Advantage.

Other qualifying events include moving outside your plan’s coverage area, your plan getting terminated for reasons outside of your control, or you qualify for Extra Help.

To find out if you qualify for a Special Election Period, give Senior Benefit Solutions a call!
Annual Election Period

The Annual Election Period (AEP) occurs each fall from October 15 through December 7. During this time, you can choose to change or drop your current Part C plan. Your new coverage will begin on January 1.

Medicare Advantage Open Enrollment Period

This is often confused with AEP. However, there are additional things you can do during the Open Enrollment Period, which runs from January 1 through March 31 each year.

During Open Enrollment, you may disenroll in your current MA plan and switch back to Original Medicare. The opposite is also true – you may switch from Original Medicare to Medicare Advantage.

You may also switch MA plans, disenroll from your Part D prescription drug plan, and switch from your current Part D plan to another Part D plan.

What’s the difference between HMO And PPO Medicare Advantage Plans?

The basics of Medicare Advantage PPO and HMO plans are the same. However, there are some differences.

An HMO plan does not allow you to receive care outside of the plan’s network. Going outside the network means that you will be responsible for all expenses. PPO plans offer some benefits if you go outside of the network, just not as much as you would receive if you stayed in the network.

A PPO plan does not require you to have a Primary Care Physician (PCP) or have a referral from that PCP to see a specialist. An HMO plan requires you to have a PCP and receive a referral for specialists.

PPO premiums are usually higher because they have more flexibility.

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