Are prescription drugs covered?
Prescription drugs are covered in most cases in HMO plans. In case you want prescription coverage, join a plan that provides so.
Do I need to choose a primary care doctor?
Yes. In most cases you are required to pick a primary care doctor in a HMO plan.
Do I need to get a referral to consult a specialist?
Under HMO plan, you are required to have a referral to consult a specialist in most cases. Certain services don’t require a referral such as yearly screening mammograms.
Can I get my health care from any hospital, doctor or health care provider?
According to HMO plan, you can get health care only from a selected number of hospital, doctor or health care provider. You are required to get services from hospitals, doctor or health care providers that are mentioned in the plan’s network. Certain plans allow you to consult people that are not in the network, usually at a higher cost. This is known as HMO with point-of-service option (POS).
What else am I supposed to know about this plan?
You plan will inform you in case your health care provider or doctor leaves the plan. You will have to pick another doctor in the plan. You will have to bear the entire health care expenditure in case it is incurred from health care provider from outside the plan’s network. Follow all the rules related to the plan, such as getting approval for a service prior to having it.
What if I have End Stage Renal Disease?
People suffering from ESRD get this health care from original Medicare. You can stay in your plan if you are already enrolled in it when you develop ESRD. You can also join another plan provided by the same company.