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HMO Plan

Since Obamacare was approved late 2013, more Americans can now find a healthcare plan that fits their lifestyle and budget. One of the more popular plans is an HMO plan, this is because it is affordable yet flexible.

A Health Maintenance Organization (HMO) plan is one type of insurance plan that offers coverage to both individuals and families. HMO plans are responsible for providing healthcare services to its eligible members. These plans work with health insurance companies, physicians, and hospitals through contracts. HMO plans provide efficient healthcare for their members at low and affordable costs. With an HMO plan, members have the freedom to choose their primary care physician within the network of provided physicians and doctors. The Primary Physician can refer you to other specialist physicians for treatment.

Members under HMO plans require a referral from their primary care physician in order to see other specialists. HMO covers the care provided by physicians who agreed by contract to treat patients. They are usually signed under the HMO’s rules and agreement. In return, physicians will receive access to more patients. In some cases, it may not be necessary for you to pay a deductible and/or copayments.

HMO plans provide coverage for preventive care services. Examples are check-ups, immunizations, x-rays, and mammograms.

  • HMO plans have a Point of Service option. This is useful if you visit a physician outside the health plans’ network, but the cost is higher. You might pay for the full cost.
  • They provide extra help for Medicare prescription drug coverage.
  • If your primary care physician backs out from the network, you are responsible for choosing a new physician.

The government provides a stipend to HMO for every Medicare member enrolled within the policy. Health Maintenance Organization plans that sign a contract with the Medicare Advantage Program are known as Medicare HMOs. In most cases, the stipend is limited and additional coverage may be needed to cover a patient’s medical needs. When you sign up for Medicare HMO, you agree to receive all its benefits through HMO. All medical care should be approved before the service is paid. If not approved beforehand, the bill could not be paid through Medicare or the HMO. If you are seeking health care through an HMO plan, you can receive a free quote online through Blue Sky Coverage.

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