Discovering that Original Medicare (Part A and Part B) doesn’t provide enough coverage is a tough pill to swallow. Original Medicare merely covers 80% of Part B expenses after the annual Part B deductible is met. The remaining total is your responsibility leading to potentially tens of thousands in expenses each year. Seniors enrolling for the first time are often shocked that Original Medicare doesn’t include any prescription drug, hearing, or vision costs.

Partial Health Coverage is not enough, Healh Management Organizations (HMO) can help

For most, Original Medicare (Part A and Part B) doesn’t provide enough coverage. Under traditional medicare (parts A and B) there is no coverage for any prescription drug costs. This lack of coverage has led nearly half of all Medicare members to opt for Medicare Advantage. Medicare Advantage HMO plans succeed at bridging the gap between original Medicare and costlier private health insurance.

What does having an HMO accomplish?

Health Management organizations or HMOs are also known as Medicare Advantage (Part C) providers.  These plans these providers offer cover everything Medicare covers plus additional benefits such as prescription drug coverage (Part D).  vision and hearing exams, preventive dental coverage, and even free gym memberships are additional benefits these providers offer.


Medicare Advantage HMO plans help you save money by having low monthly premiums and featuring out-of-pocket maximums. These cost maximums limit the total amount in a given year a member can be required to pay.

Original Medicare has cracks that HMOs can fill.

Original Medicare offers no coverage for prescription drugs, routine vision, hearing exams, or any other service. In order to have enough coverage, many people choose to enroll in an HMO plan or a Medicare Supplement plan. 48% of medicare members have made the switch to Medicare Advantage.

What are the advantages of an HMO plan?

Seniors are often drawn to HMO plans because they cover everything Original Medicare covers plus additional benefits. HMO plans generally have lower monthly premiums than Original Medicare or Medicare Supplement plans. 


Most if not all part C HMOs are available with prescription drug coverage consolidating medical and drug coverage into one plan.

How to compare different Medicare Advantage HMO plans.

When deciding on an HMO plan you should be considering the following distinguishing factors:


Current Healthcare needs 

The frequency at which you visit the hospital or doctor should affect how you look at monthly premiums. Low monthly premiums are always associated with higher copays.

Someone in good health that requires few healthcare visits annually will benefit from having a lower monthly premium but higher copays. The inverse is true for someone who may need to see a specialist or other doctor multiple times a month. This person would benefit from having a higher monthly payment associated with a lower out-of-pocket cost per visit.



Monthly Budget 

You will need to consider more than just the cost of a doctor’s visit when comparing different HMO plans. There are many different figures to compare that will affect the total cost of a given HMO option. 


Hmo plans feature an out-of-pocket maximum. This describes the maximum amount that you would ever have to spend on medicare in a given year. Knowing this amount will help you to stay on top of your monthly budget.


For Original Medicare and Medicare Supplement plans, the amount you may have to pay out of pocket in a year is uncapped.


Primary Care Physician (PCP)  – PCP is a doctor who works together with a

team of specialists to help you stay healthy and get the right care for you.  Medicare Advantage HMOs feature networks of PCPs and it is essential to make sure your doctor is approved. 


A call to your doctor’s office for a referral is a good start to finding the right HMO for you. Your doctor will know what HMOs that they currently work with and which ones to stay away from. )


Prescription Drug coverage 

An HMO plan offers Medicare part D prescription drug coverage in addition to standard medical coverage. This for many is the deciding factor between an HMO or a Medicare Supplement plan. A Medicare Supplement plan requires its members to enroll in a separate prescription drug plan.


Taking care of your health pays many dividends

Being in good health saves not only you but your medicare provider money. This incentivizes HMOs to provide preventative care and other services at as little cost to you as possible.  By comparing providers and choosing the right HMO plan with the right PCP you can certain that your health needs will be taken care of.


Research as many different options as possible

It is important to consider different case management systems utilized by Medicare Advantage providers. These case management systems aim to lower costs on their end by ensuring you are in good health. For some, these case management systems are not for them, and would prefer to remain autonomous.


HMO plans are subject to enrollment deadlines. By signing up for your Medicare advantage when first eligible, you can avoid paying any late penalties that may be assessed by medicare.



Regardless of health Insurance policy, you can be assured that your health care is our number one priority. We have found that our patients are getting better benefits with Medicare Advantage Plans and strongly recommend that you explore your Medicare Advantage options.


At Meadowcrest Family Physicians our commitment to care goes much beyond our office. If you need additional information regarding Medicare Advantage we have resources to help. Please make an appointment with our in-office rep to learn your options.