HMO Guide for Seniors - Office of the Patient Advocate - State of ...

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Questions & Answers
How can I find out exactly
what my Medicare HMO
covers?
Your HMO must give you
a written list of what your
plan does and does not
pay for. This may be called
the Evidence of Coverage
or Summary of Benefits.
If you do not have one,
call your plan.
Can I use any benefit?
You can use your benefits
when they are needed for
your health care. If you
have a problem getting
services you medically
need, see page 58.
What should I do if
I’m sick?
If you’re sick, call your
doctor. Or call your Medicare
HMO’s advice nurse
if there is one. You may not
need to visit the doctor’s
office if they can tell you
what to do to feel better.
But if you think you need
an appointment, make sure
you get one.
things you can do
Learn About Your Benefits
Your Evidence of Coverage is your contract with
your HMO. It explains your benefits and fees.
For easier reading, ask for a Summary of Benefits.
Have a question? Call your HMO or HICAP.
When You Travel
Make sure you know your HMO’s rules for getting
care away from home.
HMOs only pay for urgent and emergency care
outside the service area.
You usually need your HMO’s approval to get
urgent care.
Always take your membership card and extra
medication with you when you travel.
Vision, Hearing, and Dental Care
Some Medicare HMOs offer benefits that Original
Medicare does not cover, such as dental, vision, or
hearing care. Some plans cover part of the cost of
glasses or hearing aids. Ask if your plan covers
these services, or if you could buy coverage for an
extra fee.
where to find help
1-800-Medicare
Information on Medicare benefits
1-800-633-4227 www.medicare.gov
HICAP (Health Insurance Counseling & Advocacy)
Free information and counseling on Medicare
1-800-434-0222 www.aging.ca.gov/hicap