Ashford Insurance

Texas Medicare Advantage HMO Plans

Medicare Advantage HMO Made Easy

Texas Medicare Advantage HMO Plans

Also called Medicare Part C, a Medicare Advantage plan is a type of Medicare plan that will provide you with all your Medicare Part A and Part B benefits, but can include additional coverage such as prescription drugs, dental, vision, and health wellness plans.

When you’re enrolled in a Medicare Advantage plan, most Medicare services are covered by the plan that isn’t paid for under Medicare Parts A and B.

What is Medicare Advantage?

Medicare HMO plans and other types of Medicare Advantage plans are great options for people who want more coverage than what Original Medicare provides.

Original Medicare is what everyone who has Medicare will have, but its coverage is limited. Medicare Advantage plans can add anything from extra medical coverage to additional benefits like home healthcare, telemedicine, and full dental coverage.

Many MA plans can offer coverage for whole health benefits. Along with additional medical and dental benefits, MA plans can offer coverage for meal delivery, non-emergency medical transportation, and even fitness classes!

What Is a Medicare Advantage HMO?

An HMO, or Health Maintenance Organization, is a type of Medicare Advantage (MA or Part C) plan. HMO plans always offer the same benefits as any other Medicare plan, but they are also able to provide additional benefits, many plans include vision, dental, and hearing coverage.

HMO plans are different from other Medicare Advantage plans because they require a strict network, and you will usually need to select and stick with one primary care doctor.

Pros and Cons of Medicare HMO Plan Networks

The HMO option is certainly not for everyone. Having a strict network means that you will turn to the same doctor for most of your healthcare needs.

Some plans are called “HMO POS,” or HMO Point-of-Service plans. These allow you to see providers outside of your network for certain services. If you need to use that benefit, you will usually have to get approval from your plan first, and your provider needs to recommend the other provider.

For example, if your primary care physician (PCP) suggests that you need to see a nutritionist or other specialist, your PCP can refer you to a nutritionist that he or she trusts and send a request for coverage to your HMO. The “con” to the HMO option is that your plan can deny your out-of-network coverage.

The “pro” to selecting one primary physician and having a Health Maintenance Organization is that all of your care is grouped together and managed in one place. Your providers usually work together to manage your care, preventing unnecessary costs.

Medicare HMO vs. PPO

Where an HMO requires a very specific network, a PPO, or Preferred Provider Organization, can cover services outside of your network. With a PPO plan, you’ll be able to see any provider without needing a referral from your primary physician.

Granted, the added flexibility of a PPO plan comes with a higher premium than an HMO plan. If costs are your primary concern, HMOs are the way to go – but if you can afford the flexibility, a PPO may be for you.

CMS Star Ratings for Medicare Advantage HMO Plans

The Centers for Medicare and Medicaid (CMS) issues a quality rating for Medicare Advantage plans. CMS awards between one and five stars based on the quality of patient care the plan provides.

Medicare Advantage plans are rated based on the following criteria:

  • How easy it is to access preventive services (such as annual physical exams and health screenings)
  • Care coordination between providers
  • How often do plan members receive treatment for chronic conditions
  • Member satisfaction
  • Plan performance from year to year
  • Customer service quality

Five-star HMO plans may be available in your area. 

HMO Eligibility and Costs

Most people who are eligible for Medicare are eligible for HMO plans. The only exceptions are that not every county has HMO plans available, and most HMO plans do not accept Medicare beneficiaries with ESRD (End-Stage Renal Disease).

Just like your Original Medicare coverage, you will receive a card in the mail when you enroll in an HMO plan. When you visit a doctor or hospital, use your HMO card instead of your Medicare card to get the most coverage.

Every Medicare Advantage plan is different, but you will generally be responsible for paying certain costs.

All HMO plans come with a premium you will owe every month, but some are as low as $0.

You’ll also be responsible for paying copays such as $10 or $20 when you see a doctor and you may have to pay a deductible before your coverage starts.

A licensed agent with Ashford Insurance can help you determine if an HMO is right for you. Our agents can help you find the right plan based on your budget and lifestyle needs. To learn more, call 817-952-3153.