There are several differences in costs and coverage between Original Medicare and Health Maintenance Organizations (HMOs). The table below compares these two ways of getting Medicare benefits. If you are interested in joining an HMO, make sure to speak to a plan representative for more information.

Original Medicare Medicare HMO
See any provider and use any facility that accepts Medicare (participating or non-participating) See only in-network providers
 
Visit doctors anywhere in the U. S. Visit doctors only in your plan’s service area, except in emergencies or when care is urgently needed
 
Do not need referrals for specialists Typically need referrals for specialists
 
Does not cover vision, hearing, or dental services May cover additional services, including vision, hearing, and dental (additional benefits may increase your premium or other out-of-pocket costs)
 
Sign up for a stand-alone prescription drug plan (Part D) In most cases, plan provides prescription drug coverage (you may be required to pay higher premium)
 
Charged for standardized Part A and Part B costs (premiums and other cost-sharing for Part D vary depending on plan) Cost-sharing varies depending on plan
 
No out-of-pocket limit Annual out-of-pocket limit for in-network care (maximum is $6,700 in 2020)
 

Remember, if you enroll in an HMO you cannot sign up for stand-alone prescription drug coverage. Make sure your HMO plan provides Part D coverage if you need it.

If you have Original Medicare, you also have the choice to purchase a supplemental insurance policy, or Medigap. Medigap plans cover Medicare cost-sharing and offer other benefits, charging an additional premium for this coverage. You cannot enroll in a Medigap plan if you have Medicare Advantage.

Return to: Medicare Advantage

This content was created and copyrighted by the Medicare Rights Center ©2020. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.

YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.