HMO Plans

Health Maintenance Organization plans are a type of Medicare Advantage plan. Medicare Advantage plans are offered by private insurance companies and provide the basic benefits offered by Medicare Part A and Medicare Part B, along with some additional benefits such as dental care, vision, and prescription drug coverage.

Medicare Advantage Health Maintenance Organization plans involve in-network medical care. This means that enrollees are allowed to choose from a list of in-network providers for medical services. If you select a health provider outside the network, you may have to pay the whole amount or a higher out-of-pocket cost. The only exception to receiving coverage outside the network is if you need dialysis, urgent care, or are traveling. Each HMO plan has specific guidelines for out-of-network care as some HMO plans may allow you to visit providers that are not in the network.

However, many HMO plans may require you to choose a primary care physician within the plan’s network.

Most HMO plans require a referral to see a specialist except for certain preventive screenings. Some HMO plans may also offer prescription drug coverage. However, it is important to confirm before you enroll in a plan. Also, if you have an HMO plan, you can visit any medical center or doctor’s office as long as they are within the plan’s network.

The main advantage of HMO plans includes low premiums and deductibles.

If you need further assistance enrolling for a Medicare Advantage HMO plan in Oregon, do not hesitate to reach out to us for help. We are prepared to help you get the best plan for your healthcare needs.