Plans & Coverage
Medicare HMO Plans
An HMO (Health Maintenance Organization) is a type of Medicare Advantage plan that generally uses a provider network for non-emergency care. Many HMOs require referrals to see specialists, while HMO-POS plans may cover some out-of-network services. Rules, costs, and coverage vary by plan, so check the plan's Evidence of Coverage and confirm your providers before enrolling.
Pros and cons
Some HMOs have low or $0 plan premiums, set copays, or extra benefits. In most HMOs, routine non-emergency care generally must be in-network, and referrals may be required. Emergency and urgently needed care have different rules; HMO-POS plans may cover some out-of-network services. Check the specific plan's costs, referrals, and provider network.
Questions, answered
What happens if I see an out-of-network doctor on an HMO?
Routine out-of-network care generally isn't covered by an HMO, but emergency and urgently needed care are treated differently, and an HMO-POS plan may cover some out-of-network services. Check the plan's rules before receiving non-emergency care outside its network.
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