Why Do Some Beneficiaries Enroll in a Medicare Advantage HMO Plan?

As an insurance agent, who sits with clients regularly, many a time, when I mention the acronym HMO, people immediately look up and ask why they should choose an HMO. Well, let me tell you that there are several great reasons why a person should consider enrolling in an HMO.  The very first reason – which probably is important to a lot of consumers – is cost.  There are many HMO plans with very low and even $0 monthly premium, in addition to what consumers pay to be on Medicare. Most of these plans have low copays when you see a doctor, get X-rays done or even when you go to the hospital. The best part is that a lot of these plans include extra benefits like a gym membership, over-the-counter items like vitamins, pain relievers, cough, cold and allergy medications, dental coverage, hearing aids, and even a personal emergency response system.  Think back to the famous 80’s “I’ve fallen and can’t get up” commercial. Many would agree that the extra benefits of these plans can be quite substantial.

First things first, we want to make it clear that these plans are not for everyone. A consumer gives up some freedom when they choose to go on a plan like this. One such restriction is the liberty to simply go to any Medicare-participating doctor. That said, HMO plans do have networks of physicians and you will have to choose a primary care doctor and get referrals to see a specialist. Incidentally, such petty sacrifices are usually overweighed by the benefits of an HMO plan in the long run.

If you have a doctor who you wouldn’t want to be without and you are also unable to find a plan they work with, obviously an HMO isn’t for you. However, if your doctors are in network with an HMO or you don’t feel married to any particular doctor, we would highly recommend taking a look at an HMO. It could make a lot of sense for you.

If you’re on the fence between choosing a Medicare Advantage HMO or a Medicare Supplement, there is some good news for you! According to the Centers for Medicare & Medicaid Services’ annual guide, you have the right to try a Medicare Advantage Plan, and you can still buy a Medigap policy if you change your mind later.

On Page 23 of “Choosing a Medigap Policy,” it reads: “You have a guaranteed issue right if you joined a Medicare Advantage plan like an HMO or PPO or Programs of All-Inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65 and within the first year of joining, you decide you want to switch to Original Medicare. You have the right to buy “Any Medigap policy that’s sold in your state by any insurance company.”  It just gives you peace of mind when selecting a Medicare Advantage Plan.

If you have any other questions, feel free to call our office at 210-908-6565 and we can connect you with a licensed agent to look up the plans specific to your area!