Health Maintenance Organizations (HMO’s) Versus Medicare Fee-For-Service
- dedar_dev
- January 14, 2016
- Blog
- No responses
What should I consider when joining an HMO?
• Coverage. Most plans cover similar benefits, but the differences are in the details. Look at areas like mental health, home care, or chiropractic care, or anything that is particularly important to you.
• Choice. Is there a certain doctor you’d like to choose either for routine care or specialty care? Do you have a favorite hospital? Some plans offer a “point-of-service” program that lets you get care from doctors or hospitals that are not part of the plan’s network, but you’ll pay more for it.
• Convenience. You probably want a plan that has doctors located near your home or office. But for you, convenience might also mean that it’s easy to get prescriptions filled, or that evening and weekend appointments are available.
• Cost. If you are in a Medicare managed care plan, there may be no premium. Ask Dr. Shah or any of her staff members to let you know her preferred choice.
How is Medicare HMO coverage better than Medicare fee-for-service coverage?
These are a number of possible benefits:
Preventative Care. Insurance companies generally pay for medical services only upon illness or injury. HMO’s are supposed to provide medical services that prevent illness or injury, making medical care both higher in quality and cheaper in the long run. One example is physicals: HMO’s often require that members undergo physicals; traditional Medicare fee-for-service usually refuses to pay for physicals. Broader health coverage. HMO’s sometimes offer more services and broader coverage than Medicare policies, even when those policies are supplemented with Medigap insurance.
Dr. Shah and all of her offices accept WellCare HMO and Humana members, Freedom, Optimum and United. If you have any questions or may be interested in converting to a HMO program, please speak with one of staff in the office.