From provider network size to coverage options to price, there are a lot of myths out there about Health Maintenance Organizations (HMO) Medicare Advantage plans. With Medicare’s Annual Election Period (AEP) here, we want to make sure you have all the information you need about Medicare Advantage plans to help you make an informed choice. Join ApexHealth as we debunk five myths about HMO Medicare Advantage plans. But before we debunk these myths, let’s start off by defining HMO Medicare Advantage plans…

What is a HMO Medicare Advantage plan?

HMO stands for health maintenance organization. An HMO plan is a type of Medicare Advantage plan, and these plans provide you with the same benefits, protections and rights as Original Medicare, but with different costs and rules. These plans (such as those offered by ApexHealth) come with extra supplemental benefits you might need such as dental, vision and hearing coverage, OTC allowances or gym memberships.

HMO Medicare Advantage plans require you to have a primary care physician (PCP) – a doctor or other provider trained to give you basic care – to see first for most health problems and to make sure you get the care you need to keep you healthy. They’re able coordinate with other doctors, health care providers and specialists to coordinate your care and refer you to them. Just remember these plans have networks of health care providers which include doctors, other health care providers, hospitals, pharmacies and facilities. You’ll need to see providers in your network, except in cases of emergency.

Myth #1: HMO Medicare Advantage plans have a limited choice of network options 

HMO Medicare Advantage plans have networks of health care providers which include doctors, other health care providers, hospitals, and facilities. And while plans require that your PCP, hospitals, service providers, and specialists be within the plan’s provider network, most networks are by no means “too small.” 

ApexHealth is proud to work closely with an integrated network of providers and hospitals, anchored by Atrium Health and Atrium Health Wake Forest Baptist, to ensure our members get unmatched expertise and personalized care. With access to Atrium Health’s nationally recognized physicians and the latest treatment options, combined with the premier customer service of ApexAssistants, ApexHealth provides a more accessible, personalized experience so that you can live life boldly.

Myth #2: All HMO Medicare Advantage plans are the same

There are differences in Medicare Advantage plans based on extra benefits, provider networks, prescription drug coverage, premiums, and more. Find the plan that works best for you within your service area and use our handy plan comparison tool if you’re interested in learning more about ApexHealth’s Medicare Advantage plans.

Myth #3: HMO Medicare Advantage plans won’t cover me when I am out of my service area

In general, Original Medicare and Medicare Advantage plans are required to cover emergency and urgent care anywhere in the U.S. without any additional costs or rules about coverage. ApexHealth provides worldwide emergency services coverage outside of the U.S. and its territories. Limits and cost-sharing applies. The best advice is to check what a plan covers, and if you’re a member of a plan, contact your plan directly if you have any questions.

Myth #4: HMO Medicare Advantage plans are only for people with excellent health

You can never be rejected by Medicare because you’re sick or have a pre-existing condition. The same applies for Medicare Advantage plans. A plan cannot deny you coverage based on health status.  

Myth #5: HMO Medicare Advantage plans are too expensive 

See for yourself! Original Medicare leaves some significant coverage gaps that can be filled by purchasing a Medigap or Medicare Advantage plan. Check to see Medicare Advantage plans available in your service area. You’ll see plans with different premiums, copays and deductibles. Some plans will even have a $0 premium and/or a $0 deductible! Remember that all Medicare Advantage plans have a maximum out-of-pocket (a yearly cap on out-of-pocket costs for medical care). This means that once you reach this limit, you’ll pay nothing for covered services.

If you have any questions, we’re always here to help! Call (844) 279-0508 (TTY: 711) to speak with an ApexAssistant. Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.

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