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

6
What Is a Medicare HMO?
M
edicare HMOs are a kind of Medicare Advantage plan. The
government pays your Medicare HMO to cover your health care.
You are still in Medicare when you are in a Medicare HMO.
“We had an
HMO for a long
time. When we
got Medicare, we
changed to the
Medicare version
of our HMO.
Some of our
benefits and
costs changed.”
If you join a Medicare HMO, you must get your Medicare services
through your HMO. You will have all the benefits covered by
Original Medicare. For a list of these benefits, see page 34.
An HMO is a kind of health insurance. HMO stands for health
maintenance organization.
Each HMO has a network of doctors, labs, hospitals, and
other providers. You get your health care from these providers.
Usually you have a primary care doctor. This doctor gives you basic
care, oversees your treatments, and refers you to specialists.
To Join a Medicare HMO
You must live in the area the HMO serves.
You must have Medicare Part A.
You must pay your Medicare Part B
premium to Social Security.
You must also pay a premium to the HMO.
If you want prescription drug coverage
(Medicare Part D), you must get it from
the HMO. You cannot join a Medicare
HMO and enroll in a separate Part D
prescription drug plan.
If you are on kidney dialysis, you cannot
join a Medicare HMO. However, if you
are already in one, you can stay in it. For
more information, call 1-800-MEDICARE.
© Fotosearch/Digital Vision