HMO Medicare Advantage Plans

Butterfly in field of Flowers - Understanding Medicare Advantage HMO plans HMO Plans
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How Does an HMO Plan Work?

A Medicare Advantage 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!

You may be eligible to enroll in a Medicare Advantage plan during your Initial Coverage Election Period (ICEP), when you become eligible for Medicare Parts A and B. This is usually during the three months prior, the month of, and the three months after your 65th birthday month or your 25th month of disability.

Medicare's Special Election Period allows you to enroll in a Medicare Advantage plan if you meet other conditions. Find a list of qualifying conditions.

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. Our Today's Options® HMO plan gives people with Medicare in Central New York a new option for 2018. Enroll in an HMO plan now.

By choosing a 2018 TexanPlus HMO/ HMO-POS plan or Today's Options HMO plan, you’ll get:

  • Affordable coverage – no monthly plan premiums and low cost sharing

  • Preventive care at no cost – $0 copays for preventive screenings

  • Drug coverage – plans available with comprehensive Medicare Part D prescription drug coverage

  • Extra benefits and services not covered by Original Medicare

  • A yearly limit on what you could pay out-of-pocket – so you’re protected in the event that you have a significant health situation and expense.

  • And much more!

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 Medicare Advantage 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, premium and/or copayments/co-insurance may change 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. You may enroll in the plan only during specific times of the year unless you qualify for a Special Election Period (SEP) or Initial Coverage Election Period (ICEP). For TexanPlus HMO-SNP: This plan is available to anyone who has both Medical Assistance from the State and Medicare.

Looking for Group Plan information?

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.

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