Medicare Health Maintenance Organization (HMO)
If you enroll in a Health Maintenance Organization (HMO) plan, you must obtain services from a designated network of doctors, hospitals and other health care providers who have agreed to serve plan enrollees. The plan serves a limited area and you must live within the service area to enroll. Generally, if you receive unauthorized care outside the plan network, you will pay the entire bill unless the service is for emergency or urgently needed care.
There is little or no paperwork for the enrollee. A primary care physician (PCP) acts as a gatekeeper to other services. Health Maintenance Organization (HMO) plans have co-payments for some services and usually offer additional benefits that Original Medicare does not, such as limited benefits for eye exams, frames, lenses.
As a Medicare beneficiary, you have the option of receiving your health care through a Medicare-contracting HMO provider, if one is available in your area. You continue to pay your Part B premium directly to Medicare and pay the plan a premium.