Medicare Advantage HMO Plans

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Private insurance providers provide Medicare Advantage HMO plans.  You have a network of hospitals, doctors, and other healthcare professionals, just like other HMO plans.  Most likely, you will need to select a primary care physician, and it will be this physician who will refer you to a specialist.  You can only receive coverage outside the network of the plan if it is an urgent or emergency, and only if you are paying out of pocket.

Despite providing greater benefits than Original Medicare, the advantage of having a network of healthcare providers is that it has a lower monthly premium than the majority of other Medicare insurance plans.

 

What advantages does a Medicare Advantage HMO Plan offer?

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If you have researched an Advantage plan, also known as a Part C plan, you are probably aware of the additional benefits it provides. Original Medicare doesn't, and there is usually no extra cost.

These advantages could include:

• Daycare services for adults

• Dental

• Fitness subscriptions

• Hearing

• nutrition education

• nonprescription medications

• Supports and services for people with long-term conditions

• transport to medical appointments

• Vision

• wellness initiatives

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The benefits for which you qualify depend on your location and the providers of your plan.

Prescription drug coverage is a feature of the majority of HMO Advantage plans. But once more, make sure to ask a certified Medicare insurance consultant about the benefits that are offered in your region.

 

When can I enroll in Medicare Advantage?

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You can enroll in an Advantage plan if you qualify for Medicare. However, there are particular windows of time when you can sign up for a Part C plan:

The initial coverage election period is a seven-month window that begins three months before the month you turn 65 and concludes three months after that month.  In the 25th month following the start of your Social Security payments, if you are under 65 and receiving Social Security disability benefits, you are eligible for Medicare.  You can sign up for an Advantage plan three months before your month of eligibility until three months after you become eligible, if that is how you are becoming eligible for Medicare.  Annual election period (AEP) — Also known as open enrollment or AEP, the Medicare Advantage annual election period runs from October 15 to December 7 each year.  The Part C plan you select at this time will start providing coverage on January 1 of the following year.  You can also add, modify, or remove current coverage throughout this period.  Open enrollment for Medicare Advantage plans is available during this time, and you can switch between them or cancel them to go back to Original Medicare.
 

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Special Election Period — A special election period may be started for a number of reasons, each of which is specific to the individual.  If you want to know if you are eligible for a special election period, it is advisable to speak with a registered Medicare insurance agent.  We can discuss about a few typical examples, though.  You might be eligible for a special election period, for example, if you relocate beyond the coverage area of your Medicare Advantage plan, are eligible for additional assistance (such as a program that pays for your prescription drugs), or move into a nursing home. You have this period to modify your Advantage plan or switch back to Original Medicare.
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