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What You Need to Know About Medicare HMO

What You Need to Know About Medicare HMO


A Medicare HMO provides supplemental services for Medicare recipients. An HMO, or Health Maintenance Organization, is considered a managed care provider. Managed care allows the insurance company to dictate where a patient can go to receive specific medical services.

Medicare HMOs must approve the doctor, as well as any testing conducted by that doctor. For example, patients that visit a doctor not listed under the Medicare HMO, would be responsible for the full cost of the visit, as well as any testing ordered by the doctor.

However, those that have a Medicare HMO can visit any member doctors and have any testing conducted, as long as it is previously approved by the HMO. The only exception for pre-approval is emergency medical services, but that does have to be approved after the fact. Generally, the Medicare HMO must be notified within twenty four hours when individuals receive treatment in an emergency room or are admitted to the hospital, or they will not pay the bill.

In many cases, patients that seek emergency medical care, may find that their locals hospitals are not all covered by the Medicare HMO. When patients go to a hospital that is not covered, they may find that their HMO only pays a portion of the bill.

A Medicare HMO is often less expensive than other forms of insurance, but they also limit the options available to the beneficiary. In most cases however, the patient receives the same quality health care as those that are not enrolled in an HMO.