HMO: Medicare - Is It Right For You?
When it comes to getting a good health care program, there certainly are many out there. One of them, of course, is the Medicare HMO. Like any other program it has its unique features - but is it the best for you? With everyone's needs being a little different, here are some things to look at when you are considering getting your Medicare with an HMO.
What Is An HMO With Medicare?
Medicare, of course, is a government sponsored health insurance program, primarily for those who are over the age of 65. The HMO is a managed care program to provide for your health needs. Put them together and you have a government sponsored, managed healthcare system. In order to be in the program, you make a decision with the HMO, to have your Medicare benefits controlled by the HMO. You do need have parts A & B of the Medicare program in order to receive the benefits.
How Does The HMO Affect Your Coverage?
When you enroll in an HMO program, you are asked to choose a primary care physician. It is possible that your present physician may already be enrolled in the HMO program. This doctor is then referred as a "gatekeeper," and all medical services, tests, etc., do need to be approved by this doctor. The HMO does not cover anything else, except in some emergency cases. Even in those times, you still need to call the doctor's office first - except in cases where every second counts.
What Does An HMO Provide?
Just about anything that you can get under Medicare you can receive through the services of your HMO. The doctor determines what tests are to be given, along with the treatment, and makes referrals when necessary. If there is a complaint about not getting adequate medical assistance, then the procedures that need to be taken to correct the matter are clearly spelled out in the HMO member's handbook.
Another provision of the plan is that there are no deductibles, but there is a copay. This means that with each doctor's visit that you will be asked to pay a small amount - usually between $5 to $15.
An HMO also provides you with preventive medicine. This means that they ask you to come in and have regular physicals and office visits to determine your health levels at various times, in an effort to discover potential problems before they get worse.
Questions You Should Ask About Your Medicare HMO
One of the things that you need to look into is the various details of what is covered – and what is not. You will especially want to ask about what prescriptions are covered, and what is not. In all likelihood, you will need to get Medicare Part D in order to get this coverage. Also, to help you more than just the basic policy of Parts A and B, you may need to enroll in Medigap, which is designed as supplemental insurance. Find out, too, about long term care and home health care, as well as what type of health equipment costs and supplies may be needed.
It is also a good idea to research a lot more than what can be covered in this article – this is only touching the tip of the iceberg.
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Free Health Insurance Quotes
By comparing health plans with other rates, you should be able to find the right plan. You can get your free health insurance quotes at the following sites:
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