Start of Main Content

Medicare HMOs

What are Medicare HMOs?

Medicare Health Maintenance Organizations (HMOs) are a type of Medicare Advantage plan.

Medicare HMOs are offered by private insurance companies that contract with Medicare to provide healthcare coverage to eligible beneficiaries.

Like other HMOs, Medicare HMOs have a network of hospitals, doctors, and other healthcare providers to which they refer patients.

Under a Medicare HMO, beneficiaries must receive healthcare services from providers within the HMO network, except in cases of emergency or urgent care. The HMO typically has a primary care physician (PCP) who coordinates the beneficiary's care and provides referrals to specialists within the network.

Why are Medicare HMOs important to healthcare?

Medicare HMOs are important because they are one way that millions of Americans with disabilities or those aged 65 and over can get health coverage regardless of their income.

Medicare HMOs also minimize the cost of deductibles and monthly premiums by limiting coverage to in-network providers. These plans usually require members to choose a primary care provider (PCP) within their network who then provides referrals to specialists if needed.

In contrast, Medicare PPOs tend to have higher out-of-pocket costs but allow patients to see a wider range of providers within and outside of their network.