HMO Medicare Advantage Plans

Understanding Medicare Advantage HMO plans

HMO Plans

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How Does an HMO Plan Work?

An HMO plan is a Health Maintenance Organization plan where you receive care from doctors, providers or hospitals within the plan's network. In addition to providing all of the benefits of Original Medicare, many HMO plans include prescription drug coverage. Members of Medicare Advantage plans select one doctor as their Primary Care Physician. You must go through a Primary Care Physician and get a referral before seeking outside health care. Health care visits outside the network typically are not covered.

How Does an HMO-POS Plan Work?

A Medicare Advantage HMO-POS plan is a Health Maintenance Organization (HMO) plan with a more flexible network. Members of an HMO-POS plan can seek care outside of the traditional HMO network under certain situations or for certain treatment. It comes with all of the advantages of an HMO, in which your doctors and health plan are connected to make sure you get the right care at the right time. But, it has built-in flexibility, so you can go anywhere outside the HMO network for care if you want to (higher copays or coinsurance may apply).

How does an HMO-SNP Plan Work?

A Medicare Advantage HMO-SNP plan is a Health Maintenance Organization- Special Needs Plan (HMO-SNP) that includes all of the benefits of Original Medicare plus the additional benefits of prescription drug coverage. This type of plan provides focused and specialized care for specific groups of people, such as Dual Eligible beneficiaries who are enrolled in Original Medicare (Part A and B) and who receive state Medicaid benefits. Coverage benefits, provider choice and drug formularies are tailored to the needs of the specific groups they serve.

Enroll in a Medicare Advantage HMO Plan Today!

The Medicare Annual Election Period (AEP) has begun. Don't miss your opportunity to enroll during the AEP. If you plan to have Medicare Part C (Medicare Advantage) or Part D prescription drug coverage on January 1, 2016, it's important that you review your options and make your choice now, during the Annual Election Period.

TexanPlus® offers HMO and HMO-POS plans in Houston/Beaumont and HMO plans in Dallas/Fort Worth. TexanPlus also offers HMO-SNP plans to people with Medicare and Medicaid in Southeast Texas in 2016. Our Today's Options® HMO plan gives Medicare beneficiaries in Syracuse, New York a new option for 2016. Enroll in an HMO plan now

You may wonder how our HMO and HMO-POS plans compare to each other. They are similar in many ways. In both HMO and HMO-POS plans:

  • You receive care from a network of doctors, hospitals and other healthcare providers;

  • Your doctors may be part of a Local Physician Organization (LPO) and may refer you to specialists or providers in the LPO; and

  • You'll work closely with your Primary Care Physician (PCP) to manage your care and coordinate your treatment.

There are some important differences between our HMO and HMO-POS plans:

  • In an HMO plan, you'll be responsible for any fees for services provided by doctors or hospitals outside your PCP's LPO, except in emergency or urgent care situations.

  • In an HMO-POS plan, you have the flexibility to receive services from doctors or hospitals outside of your PCP's LPO, however, at a higher copayment or coinsurance, except in emergency or urgent care situations.

Enrollment disclaimer information:
You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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If you are a member of the City of Houston Employer Group enrolled in a TexanPlus® HMO plan, click here to see your plan documents.