Frequently Asked Questions about Medicare HMO Plans

What is a Medicare HMO Plan and How does it Work?

A health maintenance organization is also called as an HMO plan. It is suitable for those people who are looking for complete health insurance. Medicare HMO plans provide coverage for most of the health care expenses. Under Medicare HMO Plans, a person needs to give monthly premium along with co-payments for his visits at the physician and prescription medicines.

Medicare HMO Plans demand that the above mentioned amounts are paid when you receive services. The good part about Medicare HMO plans is that your monthly premiums won’t rise in case you receive more Medicare health care.

Medicare HMO Plans

Buying Medicare HMO Plans:
The first step you need to take in order to purchase a Medicare HMO Plan is to choose your PCP. PCP would be a doctor within your plan’s network and in case you need to see any other medical specialist within your network; you would require a referral from your PCP first.

Prior to choosing a Medicare HMO Plan, it is ideal to check out the provider network of all the major Medicare companies. A smaller network is most likely to cut-down your options; for instance, some networks may have very few or no doctors present.

Deductibles in Medicare HMO Plans are almost negligent however, very few deductible-free Medicare Health Insurance plans are being offered these days.

The highest costs crop up when you visit any physician outside your network. Under most circumstances, you would be exclusively responsible for paying the entire cost of the medical care you have received outside your Medicare HMO Plan network.

A Medicare HMO plan subsidizes health care costs up to a great extent by giving fixed monthly fees to all the physicians in their networks. Hence, they generally bill Medicare HMO plans less than their present rate. The out-of-pocket cost for seeing a PCP within the network is a co-payment between $10 and $50. Then again, doctors outside of that network do not have such motivation to absorb their costs.

Medicare HMO Plans are significantly lay emphasis on preventive care. Large numbers of specialists think that such type of focus could end in long term Medicare benefits and cost diminutions. Medical Tests and initial medication are included in an average Medicare HMO plan, permitting a lot of patients to take advantage of Medicare health care sooner.

Patients with HMO Medicare plans are more liable to catch diseases, like cancer, in their earliest phases. When illnesses are not very grievous, medication are more affordable and more effectual. This can lead to better health effects, in addition to lower Medicare health care costs.

HMO Medicare Plan

How to Decide Whether Your Organization Requires a Medicare HMO Plan?
Prior to deciding on a Medicare HMO Plan, ensure that your Medicare HMO would fulfil your organization’s requirements. You also need to make sure that the Medicare HMO plan is dependable and it caters your special needs.

In case your organization already has Medicare providers and experts, find out if you can use them again or not to buy Medicare HMO plans. Prior to joining any Medicare HMO Plan, also double check if the HMO is offering top-notch Medicare health care in your area.

Advantages of Buying a Medicare HMO Plan:
There are several advantages of buying a Medicare HMO plan. An individual, who has an HMO Medicare plan, can receive services by a PCP who would know particulars about the person's social, fiscal, family and personal situations. The PCP would then organize the person's Medicare health care in such a way that fewer services will likely be utilized.

Another plus point of buying a HMO Medicare Plan is that your PCP would be available to offer you Medicare health care services as and when you need them. Your PCP will also perform some medical tests and treatments prior to sending you to some specialist for advance treatment.

In case you go with a Medicare HMO plan, but need the help of a Medical specialist, you can get in touch with a member of the network who has contracted work with a HMO.

Medicare Advantage Plan
Monthly Payments (Average)
Number Of MA Contracts
Advantage Plan Penetration
United States $734 United States 428 United States 17.5%
Alabama $692 Alabama 41 Alabama 15.2%
Alaska NA Alaska 39 Alaska 0.5%
Arizona $651 Arizona 50 Arizona 30.1%
Arkansas $640 Arkansas 39 Arkansas 8.23%
California $652 California 52 California 30.7%
Colorado $649 Colorado 37 Colorado 28.2%
Connecticut $681 Connecticut 40 Connecticut 9.1%
Delaware $658 Delaware 37 Delaware 2.23%
District of columbia $776 District of columbia 41 District of columbia 8.12%
Florida $840 Florida 74 Florida 23.1%
Georgia $680 Georgia 49 Georgia 8.1%
Hawaii $639 Hawaii 41 Hawaii 34.4%
Idaho $647 Idaho 40 Idaho 18.2%
Illinois $680 Illinois 56 Illinois 7.22%
Indiana $641 Indiana 45 Indiana 9.5%
Iowa $618 Iowa 42 Iowa 11.8%
Kansas $675 Kansas 44 Kansas 6.2%
Kentucky $653 Kentucky 45 Kentucky 8.4%
Louisiana $855 Louisiana 42 Louisiana 16.1%
Maine NA Maine 38 Maine 2.23%
Maryland $815 Maryland 41 Maryland 5.5%
Massachusetts $737 Massachusetts 42 Massachusetts 14.2%
Michigan $816 Michigan 44 Michigan 14.1%
Minnesota $645 Minnesota 40 Minnesota 26.2%
Mississippi NA Mississippi 38 Mississippi 6.51%
Missouri $663 Missouri 45 Missouri 15.2%
Montana $591 Montana 38 Montana 11.2%
Nebraska $650 Nebraska 37 Nebraska 8.21%
Nevada $757 Nevada 41 Nevada 29.1%
New Hampshire $653 New Hampshire 33 New Hampshire 2.1%
New Jersey $807 New Jersey 42 New Jersey 8.2%
New Mexico $651 New Mexico 41 New Mexico 20.1%
New York $811 New York 64 New York 21.2%
North Carolina $647 North Carolina 40 North Carolina 13.3%
North Dakota $591 North Dakota 37 North Dakota 5.51%
Ohio $674 Ohio 54 Ohio 17.1%
Oklahoma $666 Oklahoma 42 Oklahoma 11.3%
Oregon $647 Oregon 53 Oregon 34.3%
Pennsylvania $778 Pennsylvania 59 Pennsylvania 31.1%
Rhode Island $655 Rhode Island 37 Rhode Island 30.2%
South Carolina $646 South Carolina 43 South Carolina 8.22%
South Dakota $591 South Dakota 36 South Dakota 3.2%
Tennessee $655 Tennessee 47 Tennessee 16.1%
Texas $742 Texas 57 Texas 13.0%
Utah $644 Utah 40 Utah 16.5%
Vermont NA Vermont 34 Vermont 1.1%
Virginia $671 Virginia 43 Virginia 8.7%
Washington $644 Washington 47 Washington 19.1%
West Virginia $707 West Virginia 40 West Virginia 6.23%
Wisconsin $618 Wisconsin 46 Wisconsin 18.2%
Wyoming NA Wyoming 35 Wyoming 2.3%

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