Health Care is extremely important for New York’s seniors right now, which makes it even more important to understand the terminology, in order to be as informed as possible about what the doctor or insurance plan is trying to sell you. This week let’s take a look at understanding the “HMO”.
You might hear people refer to some health plans as HMO, which stands for Health Maintenance Organization. HMOs have their own network of doctors, hospitals and healthcare providers. These provides have agreed to accept payment at a certain level for any services they provide. This allows the HMO to keep costs in check for its members.
In most HMO Plans, you generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network. You may also need to get a referral from your primary care doctor.
In HMO Plans, you generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network, except:
In some plans, you may be able to go out-of-network for certain services, but it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option.
In most cases, prescription drugs are covered in HMO Plans. Ask the plan. If you want Medicare prescription drug coverage (Part D) , you must join an HMO Plan that offers prescription drug coverage.
In most cases, yes, you need to choose a primary care doctor in HMO Plans.
In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don’t require a referral.
Contact us to find out which HMOs are endorsed by New York for Seniors.
The post What Is an HMO? A Term To Know first appeared on Tradition Home Care.
BROWSE OUR WEBSITE
BUSINESS HOURS
Available 24/7 Service