Medicare 101

Should I pick an HMO or a non-HMO Medicare plan?


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Both HMO and non-HMO plans are offered by private health insurance companies and regulated by Medicare. With both types of plans, you would still be paying the Medicare Part B monthly premium to Medicare, so these are plans that would be in addition to, or supplement Medicare.

Option 1: HMO
HMO plans are known as Medicare Advantage plans, which is considered Medicare Part C.  (Who came up with all of this?) Most of these plans include the drug plan.

  • Pros
    • Lower monthly premiums
    • May include additional benefits like dental, vision, hearing, transportation, etc. This varies by plan.
  • Cons
    • Co-pays and co-insurance for most procedures
    • You must gain approval from your primary care physician to see specialists or to receive medical treatment.
    • Restricted provider network, which can be a big factor for those in rural or isolated areas.

Bottom line: HMO plans are best for those who want to keep costs lows and don’t expect to go to the doctor very often.

Option 2: Non-HMO

Non-HMO plans are known as Medicare Supplement or Medigap plans. In general they are plans that pay the deductibles and co-pays/co-insurance that Medicare doesn’t.

  • Pros
    • Very flexible in being able to see any doctor in any state that accepts Medicare (almost all doctors).
    • Not restricted by a “gatekeeper” primary care physician regarding which providers you can see.
    • Many plans do not have a co-pay or co-insurance for any doctor visit, procedure, or test. What you would be responsible for in these plans is just the monthly premium. Many of our clients call these the “Cadillac plans”.
    • For those with high health insurance usage with health conditions, this is a great option to control costs, because you do not have co-pays and co-insurance with most types of non-HMO plans.
  • Cons
    • Higher monthly costs
    • Does not include the drug plan, so you would choose a separate one.
    • More decisions to make, because you can take charge of the providers you see.

Our Take: Non-HMO plans are the “Cadillac plans” that offer the highest level of flexibility of any plans, at generally a higher monthly premium. It’s most suited to people that want the least hassle and controlled monthly expenses, and spend time out of their county or want to take control of their medical care.

Have any questions?
Just get in touch with one of our Heroes that would be happy to help you! We are unbiased independent brokers contracted with all of the major health insurance companies. We are 100% free to you and the prices are the same as if you went directly to the health insurance companies, but with us as your Medicare concierge we can continue to guide you in your journey.

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