Lower monthly premiums
With HMO plans, required networks keep premium costs down.
Explore Medicare Advantage Health Maintenance Organization (HMO) plans
Medicare Advantage Health Maintenance Organization (HMO) plans provide private-sector coverage that ensures policyholders receive all that’s covered by Medicare Parts A & B, plus additional benefits.
Compare available Medicare Advantage HMO plans near you.
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What is a Medicare Advantage HMO?
Many Medicare Advantage insurance providers offer two types of plan structures: Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). While PPO plans provide networks of doctors, hospitals, and other healthcare professionals and facilities, policyholders are not required to use those in-network options. With an HMO, on the other hand, policyholders must use the network of hospitals, doctors, and other healthcare professionals. Exceptions to these requirements include the following:
- Emergency care
- Out-of-area urgent care
- Temporary out-of-area dialysis
By requiring you to use in-network doctors, hospitals, and other healthcare providers and facilities, HMOs keep both premium and out-of-pocket costs lower. If you’re an HMO policyholder on a budget, you’ll save on a yearly, monthly, and per-visit basis.
Medicare Advantage HMO benefits and features may include one or more of these features
Prescription drug coverage
Some Medicare Advantage HMO plans cover prescribed medications.
Dental Coverage
Preventative dental care, such as checkups and cleanings, may be covered.
Vision coverage
Eye exams and other vision benefits may be available with Part C HMO plans.
Compare Medicare Part C plans
Coverage | HMO Plans | PPO Plans | SNPs |
Charges monthly premium | Yes | Yes | Yes |
Covers prescription drugs | Sometimes | Sometimes | Yes |
Allows out-of-network coverage | Sometimes | Yes | Sometimes |
Requires primary care physician | Sometimes | No | Sometimes |
Requires referrals for specialist care | Yes | No | Sometimes |
Frequently asked questions about Medicare Advantage HMOs
Who is eligible for Medicare Advantage HMO plans?
Medicare Part C plans such as Medicare Advantage HMO plans are available to anyone enrolled in Original Medicare (Medicare Parts A & B, coverage provided by the federal government). Medicare is available to those who qualify by age or by special qualifying conditions.
- Age: If you are a citizen of the United States who has been living in the U.S. for the previous 5 years and are 65 years of age (or approaching your 65th birthday) you are eligible to sign up for Medicare.
- Qualifying Conditions: You may qualify for early benefits if you are disabled and have received Social Security benefits for at least 24 consecutive months;
How do I enroll in a Medicare Advantage HMO?
Enroll in a Medicare Advantage HMO plan during a qualified Medicare Enrollment Period. Here are a few of the most common times of year to enroll in, or change, your Medicare Part C coverage:
- Annual Enrollment Period - October 15-December 7 each year, available to anyone Medicare-eligible
- Medicare Advantage Open Enrollment Period - January 1-March 31 each year, available to anyone already enrolled in a Medicare Advantage plan
- Special Enrollment Periods - may occur throughout the year, triggered by qualifying events
To enroll in a plan, you can compare online or speak to an agent by calling 1-888-269-5495 Monday through Friday from 6 am to 5 pm MT.
Do Medicare Advantage HMO plans charge a monthly premium?
Yes, Medicare Advantage HMO plans do charge a monthly premium. This premium is often lower than the premium associated with a Medicare Advantage PPO plan.
Are prescription drugs covered by Medicare Advantage HMOs?
Some, but not all, Medicare Advantage HMO plans cover prescription drugs. If you prefer an HMO plan with prescription drug coverage, speak to an agent by calling 1-888-269-5495 Monday through Friday from 6 am to 5 pm MT. Let the agent know your preference and they can help you find the plan that fits.
Do I need to choose a primary care provider (PCP)?
Some, but not all, Medicare Advantage HMO plans require you to choose a primary care physician. When comparing plans either online or speaking to one of our licensed agents, be sure to find out whether a PCP is required with the plan you choose.
Do Medicare Advantage HMOs cover out-of-network services?
Generally, Medicare Advantage HMOs do not cover out-of-network services. There are some exceptions:
- Emergency care
- Out-of-area urgent care
- Temporary out-of-area dialysis
Are my Medicare Advantage HMO options limited based on the state I live in?
All Medicare Advantage plans must offer equivalent coverage to that provided by Original Medicare (Parts A & B) through the federal government. What varies plan-by-plan are the additional benefits available and their associated costs. To learn what’s available in your area from carriers such as UnitedHealthcare®, WellCare, Humana and others, speak to an agent by calling 1-888-269-5495 Monday through Friday from 6 am to 5 pm MT.
Medicare resources
Medicare Advantage Plans
Learn about Medicare Advantage, also referred to as Medicare Part C, coverage.
Medicare Annual Enrollment Period 101
When is the Medicare Annual Enrollment Period? Get answers to this and other AEP-related questions.
Medicare Enrollment Overview
Get fast facts about Medicare Enrollment, including when you qualify and when to enroll.
Clearlink Insurance represents Medicare Advantage HMO, PPO, PFFS, and PDP organizations that have a Medicare contract. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
We do not offer every plan available in your area. Currently we represent 7 organizations which offer 275 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period.
For accommodations of persons with special needs at meetings call TTY 711.
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