Medicare Advantage Health Maintenance Organization (HMO)
What is an HMO plan and how does it work?
HMO stands for Health Maintenance Organization. An HMO is structured to help you save on costs by offering low, or no monthly premiums, low copayments and no deductibles. Once you’re enrolled, you’ll receive a network directory that lists the doctors and hospitals that participate in our network. To receive full benefits, you may only use these doctors and hospitals that are within our network. If you obtain routine care from out-of network providers, neither Medicare nor Blue Cross and Blue Shield of Georgia will cover the costs. You will be responsible for those “out-of-network” costs.
You don’t have to choose a primary care physician
Unlike other HMOs, you won’t be required to choose a primary care physician (PCP).
You don’t need referrals to see specialists
With our HMO, you’re free to see any specialist of your choice without having to get a referral from a PCP, which many other HMOs can require. Just remember that when you’re a member of an HMO, to receive full benefits, you may only use doctors and hospitals that are within our network.
Low copayments for doctor visits, $0 copayment for Medicare-covered preventive services
A copayment is your portion of the cost that you pay each time you visit a doctor or other health care provider. The good news is that if you are seeing a doctor for a Medicare-covered preventive service such as routine physical exams, immunizations, screenings, etc., no copayment is required for these services. (If you receive other benefits during the same doctor visit, you may pay a copayment for those services.)
Part D (Prescription) Coverage
As a member of a Blue Cross and Blue Shield of Georgia Medicare Advantage HMO, you are automatically enrolled in Medicare Part D, Medicare’s prescription drug coverage. You don’t need to enroll in a separate Part D plan. (Some plans in some states also offer plans without Part D drug coverage).
What are the advantages of a Blue Cross and Blue Shield of Georgia Medicare Advantage HMO Plan?
The main advantage of the Blue Cross and Blue Shield of Georgia HMO plan is the lower monthly premium. Because you’ll be using doctors and hospitals that are within our network, you’ll find that the savings are substantial. You’ll have low or no monthly premiums, low copayments and no deductibles.
Another advantage is that you get access to hundreds of preventive and wellness programs, discounts on products and services, and tools and kits that can help educate and guide you about ways to live a healthier lifestyle. These are extras that Original Medicare does not offer.
What are the costs?
Depending on the plan you choose, you may be responsible for a low monthly premium. Also, whenever you visit a doctor (except for most Medicare-covered preventive services,) you’ll be asked to pay a copayment at the time of service. You must also continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third-party.
Who is eligible?
You are eligible for a Blue Cross and Blue Shield of Georgia Medicare Advantage HMO plan if you are entitled to Medicare Part A, enrolled in Medicare Part B and live in the service area
(counties and states that have access to Blue Cross and Blue Shield of Georgia coverage) However, individuals with end-stage Renal Disease are generally not eligible to enroll in a Blue Cross and Blue Shield of Georgia Medicare Advantage HMO plan. The Evidence of Coverage has information on exceptions.
How do I choose a Blue Cross and Blue Shield of Georgia HMO plan?
The best way to choose is by comparing the coverage and rates of several plans. You can do this by clicking here
for plan details and benefits.
CMS Approved Date 9/2008, Material Identification M0013_09_041
Last Updated 09/2008