A type of Medicare Advantage plan where beneficiaries receive their Medicare benefits through a private health insurance company contracted by Medicare. HMOs typically require members to use a network of healthcare providers and often provide additional benefits not covered by traditional Medicare.
A group of doctors, hospitals, and other healthcare providers that have agreed to provide services to Medicare HMO members at a discounted rate.
A doctor who serves as the main point of contact for a patient’s healthcare needs within the Medicare HMO network. Members typically need a referral from their PCP to see specialists.
Authorization from a primary care physician to see a specialist or receive certain medical services within the Medicare HMO network.
The monthly fee paid by Medicare beneficiaries to enroll in a Medicare HMO plan. In addition to the Medicare Part B premium, if applicable.
A fixed amount that Medicare HMO members pay for covered healthcare services, such as doctor visits or prescription drugs.
The maximum amount of money Medicare HMO members will have to pay for covered services in a calendar year. Once this limit is reached, the plan typically covers all additional costs for covered services.
Restrictions or limitations on covered services, such as certain medical procedures or prescription drugs, imposed by the Medicare HMO plan.
Scores assigned to Medicare HMO plans by the Centers for Medicare & Medicaid Services (CMS) based on factors like member satisfaction, health outcomes, and customer service. These ratings can help beneficiaries compare plan quality.
Specific times during the year when Medicare HMO members can switch to a different Medicare Advantage plan or return to Original Medicare. Examples include the Annual Enrollment Period and Special Enrollment Periods.