These days, there are numerous types of plans offered by insurance companies for health coverage. With titles like HMO, PPO, and EPO, it’s difficult to decipher what they mean and which type of plan is best suited for you. In this first part of our series we have outlined the basic features of a typical HMO.

Health Maintenance Organizations (HMOs), were one of the first contemporary managed care plans. They are characterized by a network of providers within which members can receive covered care (with certain exceptions outlined in the policy).

If you are a member of an HMO and receive care within their specified network, there is no need to file claim paperwork. However, if you receive emergency care outside of the network a claim may need to be filed in order to receive coverage.

Members will pay a premium (usually monthly) to belong to the organization. Health Maintenance Organizations typically do not charge deductibles for care received in their network, but most plans do charge a modest co-pay for each visit (for example $15 or $30). Because they emphasize preventative care, HMO’s often cover annual physicals and well checks at no charge to the member.

Each member must have a Primary Care Physician (PCP) within the HMO network. This is an important part of the HMO system as a member will need a referral from their PCP in order to see a specialist in most cases.

Of course, it’s always best to consult your Accent Agent when thinking about joining a new plan. We can  help you determine which type of plan best fits your life.

Part A, Part B… Parts C and D. Talk about confusing! Don’t worry; we’ll break Medicare down for you so it’s easier to digest.

Original Medicare (Part A and Part B):

Part A (Hospital) - Medicare Part A covers costs associated with in-patient hospital care as well as skilled nursing facilities as long as it is for rehabilitation services. It also covers drugs that are a part of your inpatient course of treatment. However, it does not cover doctors’ fees associated with your care. There is no monthly premium for Part A but there are deductibles and co-insurance fees.

Part B (Medical) – Medicare Part B is used to cover doctors’ fees, related to necessary medical procedures as well as preventative care. It can also be used to help cover the costs of medical equipment and supplies. There is a monthly premium for Part B as well as an annual deductible.

Other Options and Add-Ons:

Part C (Medicare Advantage
Plans) – Medicare Advantage Plans work similarly to how individual health insurance does. These are offered by private insurance companies. They typically cover what original Medicare does but come with tons of added benefits like vision, dental, hearing, and prescription drug coverage. This is a great option that covers Parts A, B, and D all under a single plan.
Part D (Prescription Drug) – These plans help offset the cost of prescription drugs. They are offered by private insurance companies. Each company will have a list of drugs they covered called a formulary. In general, you need to look over the formulary and choose a company that covers the prescriptions that you have been, or expects to be prescribed.
Medi-Gap – These are supplemental plans offered by private insurance companies that cover what Original Medicare (Parts A and B) doesn’t. They do not cover prescription drugs and you cannot be enrolled in both Medi-Gap and Medicare Advantage Plans.

Switching to Medicare can be a puzzling experience but it doesn’t have to be! Our knowledgeable agents at Accent Insurance Group are here to help make your transition easy and as stress-free as possible.