Does an HMO Medicare Advantage plan cover care when I’m traveling?

Only emergency and urgent care, which must be covered anywhere in the United States regardless of network. Routine, non-emergency care outside your service area generally is not covered.

Is follow-up care after an emergency automatically covered under an HMO?

Not automatically. The emergency itself is covered, but follow-up care from an out-of-network provider may require your plan’s coordination and approval and could carry out-of-network cost-sharing without it.

Can I change my primary care provider under an HMO plan?

Yes. You can generally change your assigned primary care provider by contacting your plan directly if the relationship is not working for you.

Is an HMO a good fit for snowbirds or frequent travelers?

Generally, an HMO is not ideal for snowbirds or frequent travelers because routine care outside the plan’s service area typically is not covered. A PPO or Original Medicare with Medigap may provide greater flexibility.

What is an HMO-POS plan?

An HMO-POS plan is a hybrid HMO structure that includes a limited allowance to see out-of-network providers for certain services, usually at a higher cost than staying in-network.

What happens if my provider leaves my HMO’s network while I’m in treatment?

Continued-care protections may allow a limited period of treatment at in-network cost-sharing rates. The specific protections and timeframes can vary, so members should confirm the details directly with their plan.

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