What Is an HMO Insurance Policy for Medicare?

Medicare Advantage includes HMO plans from private insurers.

Medicare permits beneficiaries to choose original Medicare fee-for-service or one of the health plans offered by private insurers, including Health Maintenance Organization plans under the Medicare Advantage program.

HMO Benefits

Medicare HMO plans offered through Medicare Advantage can be less expensive than original Medicare and give a broader scope of benefits, including more preventive and wellness care. The trade-off for beneficiaries is the requirement to receive health care solely from the providers in the HMO.

History of Medicare HMOs

Medicare Advantage is also referred to as Medicare Part C. This option was created in the 1997 Balanced Budget Act and renamed "Medicare Advantage" in the 2003 Medicare Modernization Act. HMOs were the first private plans introduced to Medicare beneficiaries.

HMO Ratings

The federal Medicare agency collects rating information on the private plans using beneficiary satisfaction surveys, as well as objective measures such as patient outcomes data so that beneficiaries can make an informed choice on HMO plans.

HMOs and Part D

Many Medicare HMO plans contain a prescription drug benefit. Beneficiaries in those plans cannot opt out of drug coverage or choose another drug plan. Beneficiaries in HMOs without drug benefits can select a Part D plan.

Finding a Medicare HMO

Consult the Medicare plan compare tool in the Resources section to view the plan options and ratings for available Medicare HMOs in your area. The tool permits a personalized search based on an individual's needs.

References

• Department of Health and Human Services Centers for Medicare and Medicaid: Overview

Resources

• Department of Health and Human Services Centers for Medicare and Medicaid: Medicare Options Compare