Call Us Today

Medicare Advantage HMO Plans

HMO plans are the most popular type of Medicare Advantage plan. One of their draws is that they tend to have lower monthly premiums than other plans. However, you can only visit providers within the plan’s network

Some plans may even have no monthly premium aside from your Part B premium, but you should check with an experienced insurance agent licensed in Medicare plans before picking a plan for its seemingly low fees. If you would like Medicare Advantage advice today, get in contact with the team at Medicare Plans Direct.

Who can you get treatment from?

When you have an HMO plan, you can only get coverage from doctors and hospitals that are within your plan’s network. The exceptions to this are emergency care, out-of-area urgent care, and temporary out-of-area dialysis. 

If you do choose to go to a provider from outside of your network, you will be responsible for paying the full cost of their services

Do you get prescription drug coverage?

Most HMO plans offer prescription drug coverage, but you must be sure to sign up for a plan that does provide it if you are interested.

Do you need a referral to see a specialist?

You usually have to choose a primary care doctor in HMO plans, and in most cases referrals are mandatory if you would like to see a specialist. It may also be necessary to get authorization before seeking certain services, so you should always be familiar with your plan’s rules. 


Point-of-service (HMO-POS) plans are a type of Health Maintenance Organization plan which allows you to visit providers outside of your plan’s network. 

HMO-POS plans require that you choose a primary care physician to organize your care. He or she can also refer you to specialists, though referrals are not mandatory under point-of-service plans. However, you will need to speak with your doctor to get prior authorization for certain services. 

The HMO and POS portions of these types of plans have separate deductibles. Therefore, in-network visits will count towards your HMO deductible and out-of-network care will count towards your POS deductible.  

If you would like more information regarding your Medicare Advantage options, reach out to a licensed insurance agent today.

Scroll to Top