Medicare HMO: What You Don’t Know Can Harm You

What is a Medicare health policy?

medicare advantage plans 2020A Medicare health policy is a Medicare reward policy, with a health maintenance organization such as the provider network. Most Medicare Advantage plans are network based, but not all work the same way.

When applying for a Medicare health policy, you must comply with the rules established by the policy. There are two things that distinguish an HMO from other types of Advantage Policy networks.

You must choose a primary care provider and get referrals from that provider to use the services of other specialists and facilities.

You must receive all your services from the network of the health maintenance organization.

On the surface, these two points are acceptable, but they can cause problems under certain circumstances. You can get frustrated later if you don’t think about these things before registering in a policy.

Do not let that happen to you

While getting referrals for each problem limits your freedom to manage your medical care, the biggest problem arises when you need a provider or a specific type of procedure that is not offered on the HMO network.

Suppose for a minute that you are diagnosed with a rare form of cancer. The good news is that it was treated in the network with some success, but the most successful leading treatment is available only in a specialized hospital that is not in your network.

You know that this leading treatment exists and that the positive results are real. But you cannot leave the network to receive treatment. Your Medicare HMO will not pay for it. And while you have health insurance, so does Medicare.

If I had the original Medicare or the original Medicare and a supplement, I would have no trouble getting the main treatment. If you are registered in one of the 2020 Medicare advantage plans you can pay a little more and leave the network and receive the main treatment, but not with the HMO.

How should you proceed?

Medicare HMOS is popular. You will often find more HMOS in service areas with large metropolitan areas than other types of Advantage Policy networks.

It is attractive to subscribe to this type of policy because the cost-sharing values ​​(deductibles, co-payments and coinsurance) are generally lower than the policies for other types of networks. And often this policy has richer complementary rewards, such as memberships in dentistry, vision, hearing and gyms, than other non-HMO policies.

Before registering in a policy, you must thoroughly investigate the network. No one has a crystal ball, but researching a little before registering can give you a better idea of ​​the services available. Consider your health and your family’s health history to play the game that continues. Thinking about possible scenarios can save you some frustration in the future.