Medicare HMO Plans

Deciphering Coverage: When Medicare is Primary or Secondary to HMO Plans

As a Medicare beneficiary, you have numerous healthcare coverage options to choose from. However, it can be challenging to comprehend how your benefits work, particularly when it comes to Medicare HMO Plans. That’s why Integrity Now Insurance Brokers has created this guide to explain how Medicare HMO Plans fit into your healthcare coverage. You’ll gain an understanding of when these plans act as primary or secondary insurance, allowing you to navigate your benefits with ease.

Key Takeaways

  • Medicare HMO Plans can act as primary or secondary insurance.
  • Understanding the differences between primary and secondary insurance is critical.
  • There are specific benefits and coverage provided by Medicare HMO Plans.
  • Comparing Medicare HMO Plans is essential in finding the one that best suits your needs.
  • Medicare HMO Plans can be affordable options for your healthcare coverage.

Understanding Medicare HMO Plans

Medicare HMO Plans are a type of Medicare Advantage Plan that provides you with a network of doctors and hospitals to choose from. These plans combine your Medicare benefits into a single plan, making it easier to manage your healthcare coverage. Unlike other types of insurance plans, Medicare HMO Plans often require you to choose a primary care physician who will manage your care.

One of the benefits of Medicare HMO Plans is that they typically have lower out-of-pocket costs compared to Original Medicare. Additionally, many Medicare HMO Plans provide additional benefits such as routine dental and vision care, hearing aids, and prescription drug coverage. However, these additional benefits may come with certain restrictions on providers.

Integrity Now Insurance Brokers can help you compare different Medicare HMO Plans and find one that meets your unique healthcare needs. Whether you’re looking for a plan with broader provider networks or lower out-of-pocket costs, there are a variety of options available to you.

Medicare Advantage HMO Plans vs. HMO Plans for Medicare

It’s important to note that Medicare HMO Plans are one type of Medicare Advantage Plan. Other types, such as PPO and POS plans, may offer different benefits and coverage options. However, if you’re looking for a plan that restricts your provider network, Medicare HMO Plans may be the right option for you.

Medicare HMO Plans benefits

How Medicare HMO Plans Work

When you enroll in a Medicare HMO Plan, you’ll typically choose a primary care physician who will be your main point of contact for all medical services. If you need to see a specialist or receive additional care, your primary care physician will refer you to a provider within your network.

It’s important to note that if you receive care outside of your network, you may be responsible for paying the full cost of your care. Additionally, Medicare HMO Plans may require prior authorization for certain procedures or services, so it’s important to understand your plan’s rules and restrictions.

Comparing Medicare HMO Plans

When comparing Medicare HMO Plans, it’s important to consider factors such as the plan’s provider network, benefits, and out-of-pocket costs. Integrity Now Insurance Brokers can help you compare different plans and find one that fits your budget and healthcare needs.

Below is a table that compares some of the top Medicare HMO Plans:

Plan Name Monthly Premium Doctor Network Out-of-Pocket Costs
Humana Gold Plus HMO $0 Large $6,700 max out-of-pocket
UnitedHealthcare Medicare Advantage HMO $0 Large $6,700 max out-of-pocket
Anthem MediBlue Access Basic (HMO) $33.50 Basic $4,900 max out-of-pocket

Note: Table data as of October 2021 and subject to change. Always review the plan’s official website for up-to-date information.

Next, we’ll discuss the concept of primary vs. secondary insurance and how it applies to Medicare HMO Plans.

Primary vs. Secondary Insurance

When you have Medicare coverage, it can act as primary or secondary insurance depending on the situation. Understanding this concept is crucial when evaluating how Medicare HMO Plans fit into your healthcare coverage.

In general, primary insurance is the first payer for any healthcare services you receive. Secondary insurance comes into play after primary insurance has paid its share of the costs. Medicare HMO Plans can act as both primary and secondary insurance, depending on the specific circumstances.

When does Medicare act as primary insurance?

Medicare HMO Plans act as primary insurance in situations where you are receiving healthcare services from a provider that is in-network and there is no other primary insurance coverage available. This means that your Medicare HMO Plan will pay the healthcare costs according to the coverage and benefits provided in the plan.

Medicare HMO Plans as Primary Insurance

It’s important to note that not all Medicare HMO Plans will act as secondary insurance. You should carefully review your plan’s benefits and coverage details to ensure you understand how your plan will coordinate with other primary insurance coverage.

Medicare HMO Plans as Primary Insurance

If you’re searching for the best Medicare HMO Plans, look no further. Medicare HMO Plans offer a range of benefits and coverage options, making them a popular choice for those seeking comprehensive healthcare coverage. As primary insurance, Medicare HMO Plans offer many advantages to those who qualify.

Some of the benefits of Medicare HMO Plans as primary insurance include:

  • Broad coverage: Medicare HMO Plans provide coverage for a wide range of medical services, including routine checkups, hospital stays, and prescription drugs.
  • Cost savings: Medicare HMO Plans are designed to offer affordable healthcare for enrollees, with lower out-of-pocket costs and premiums than traditional Medicare plans. This makes them an excellent choice for those on a fixed income.
  • Increased accessibility: Medicare HMO Plans often provide convenient access to healthcare services, with options like telemedicine and nurse advice services.

When considering Medicare HMO Plans as primary insurance, it’s important to understand their limitations as well. These plans generally require enrollees to use providers within their network, limiting their flexibility for choosing healthcare providers.

Comparison of Top Medicare HMO Plans
Plan Name Monthly Premium Out-of-Pocket Maximum Drug Coverage
Aetna Medicare Prime Plan $0 $6,700 Yes
Anthem Medicare Preferred Standard $0 $6,700 Yes
Kaiser Permanente Senior Advantage $0 $3,000 Yes

Integrity Now Insurance Brokers is an independent insurance agent that can help you find the top Medicare HMO Plans available. We can help you compare coverage options, premiums, and deductibles to find the plan that best fits your healthcare needs and budget. Additionally, our team can guide you through the enrollment process, ensuring that you receive the coverage you need when you need it.

Medicare HMO Plans Benefits

Medicare HMO Plans as Secondary Insurance

If you already have some form of primary insurance coverage, such as an employer-sponsored plan or retiree health benefits, enrolling in a Medicare HMO Plan can provide you with additional benefits, often at a lower cost. In these cases, Medicare HMO Plans act as secondary insurance, meaning they provide coverage beyond what your primary insurance offers.

It’s important to understand how your Medicare HMO Plan coordinates with your primary insurance. Generally, your primary insurance pays first, and your Medicare HMO Plan acts as a backup. However, some plans may have limitations on what they cover if they are secondary insurance.

To ensure that you make the most of your benefits, speak with Integrity Now Insurance Brokers, an independent insurance agent. They can help you understand how your Medicare HMO Plan works with your primary insurance and ensure that you have the right coverage to meet your healthcare needs.

Benefits of Medicare HMO Plans as Secondary Insurance

When Medicare HMO Plans act as secondary insurance, they can provide a range of benefits, including:

  • Reduced Out-of-Pocket Costs: With the additional coverage provided by a Medicare HMO Plan, you may pay less out of pocket for healthcare services.
  • Access to Additional Services: Medicare HMO Plans often provide benefits that your primary insurance may not cover, such as vision or dental services.
  • Flexibility: You can choose to see providers that are in your Medicare HMO Plan’s network or out-of-network, depending on your needs and preferences.

To determine if a Medicare HMO Plan is the right choice as secondary insurance for you, compare different plans and consult with an independent insurance agent like Integrity Now Insurance Brokers. They can help you understand the benefits, coverage, and limitations of each plan, so you can make an informed decision.

Medicare HMO Plans coverage

Factors to Consider

When comparing different Medicare HMO Plans, these factors should guide your decision:

  • Coverage: Ensure the plan covers the medical services and treatments you need.
  • Cost: Consider the premium, deductible, copayment, and coinsurance rates to determine the plan’s total cost.
  • Network: Check if your preferred providers are in the plan’s network, or if you’re comfortable with the selection of network providers.
  • Customer reviews: Look for customer reviews and ratings from reputable sources to assess the plan’s overall quality and customer service.

Medicare HMO Plans Comparison

Plan Name Coverage Cost Network
Aetna Medicare Advantage HMO Comprehensive Low premiums, no deductibles, and low copays Large network with access to specialists
Humana Honor (PPO) Plan Comprehensive with extra benefits Low premiums, deductible, and copayments Extensive network including rural areas
Integrity Now Medicare Advantage Plan Comprehensive with dental, vision, and hearing benefits Low premiums, no deductibles, and low copays Access to an extensive network of local primary care physicians and specialists

Note: This table is only a sample comparison of Medicare HMO Plans. It’s important to research and compare plans in your area to find the one that meets your specific needs.

Benefits of Medicare HMO Plans

Enrolling in a Medicare HMO Plan can provide you with numerous benefits that go beyond basic healthcare coverage. These plans often include additional services and perks that can enhance your overall wellbeing and help you save money. Here are some of the advantages of Medicare HMO Plans that you can enjoy:

  • Comprehensive coverage: Medicare HMO Plans offer comprehensive coverage that includes all the benefits provided by Original Medicare. This means you’ll have access to hospital stays, doctor visits, preventive care, and prescription drug coverage.
  • Lower out-of-pocket costs: Medicare HMO Plans generally have lower out-of-pocket costs than Original Medicare, which can help you save money on medical expenses.
  • Extra services: Some Medicare HMO Plans include extra services like dental, vision, and hearing coverage, which are not covered by Original Medicare.
  • Wellness programs: Many Medicare HMO Plans offer wellness programs that can help you improve your health and prevent chronic conditions. These programs may include gym memberships, weight loss programs, and smoking cessation programs.
  • Predictable expenses: Medicare HMO Plans generally have fixed copays and deductibles, which can help you budget for healthcare expenses and avoid unexpected bills.

Medicare HMO Plans Benefits

Don’t let cost be a barrier to getting quality healthcare coverage. Schedule a consultation with Integrity Now Insurance Brokers today and discover how you can enroll in an Affordable Medicare HMO Plan that meets your unique needs.


Now that you have a comprehensive understanding of Medicare HMO Plans, you can confidently navigate your healthcare benefits. Remember that Medicare HMO Plans can act as primary or secondary insurance, depending on your circumstances. It’s essential to carefully compare different plans to find the one that best fits your needs and budget.

At Integrity Now Insurance Brokers, we understand that choosing the right insurance plan can be overwhelming. As an independent insurance agent, we can help you find the best Medicare HMO Plans available in the market. Our experienced agents will work with you to understand your unique needs and guide you through the selection process.

Whether you’re looking for comprehensive coverage, affordable premiums, or additional benefits, we have the expertise to help you find the perfect plan. Contact us today to learn more about Medicare HMO Plans and how we can assist you in finding the best coverage for you.


When should Medicare HMO Plans act as primary insurance?

Medicare HMO Plans act as primary insurance when you receive healthcare services from providers within the plan’s network, and Medicare is your only insurance coverage.

When does Medicare HMO Plans act as secondary insurance?

Medicare HMO Plans may act as secondary insurance when you have other primary insurance coverage, such as through your employer or a retiree health benefit.

How do Medicare HMO Plans compare to other types of insurance plans?

Medicare HMO Plans, also known as Medicare Advantage HMO Plans, offer comprehensive coverage along with additional benefits, such as prescription drug coverage and preventive care, that are not typically covered by Original Medicare.

What are the benefits of enrolling in a Medicare HMO Plan?

Medicare HMO Plans offer a range of benefits, including cost-savings, comprehensive coverage, access to a network of healthcare providers, and additional services like prescription drug coverage and wellness programs.

What does Medicare HMO Plan coverage include?

Medicare HMO Plan coverage typically includes doctor visits, hospital stays, prescription drugs, preventive care services, and sometimes even dental, vision, and hearing services.

How can I find an affordable Medicare HMO Plan?

You can find affordable Medicare HMO Plans by comparing different plans, considering your healthcare needs and budget, and exploring cost-saving options, such as subsidies and financial assistance programs.