H4513 049 01 - Hmo (2024)

FAQs

What does Cigna HMO stand for? ›

What is an HMO Plan? A Health Maintenance Organization (HMO) health plan offers a local network of doctors and hospitals for you to choose from.

What is an HMO? Health maintenance organizations (HMO) * have a network of doctors, hospitals and other healthcare providers who provide their services for a specific payment, which allows the HMO to maintain costs for its members. Cost and choice are the 2 features that set HMOS apart from other healthcare plans.

What's an HMO? A type of Medicare-approved health plan from a private company that you can choose to cover most of your Part A and Part B benefits instead of Original Medicare. It usually also includes drug coverage (Part D). offered by a private insurance company.

Keystone 65 Preferred Medical-Only HMO and Keystone 65 Preferred Rx HMO are Medicare Advantage HMO (Health Maintenance Organization) plans. With an HMO plan, members choose a family doctor, called a primary care physician (PCP), who provides the services they need.

An HMO is a good choice if you want the cheapest health insurance and don't mind staying within the plan's provider network. A PPO would probably be the better option if flexibility is what you prefer, even if it means higher health insurance costs. Out-of-network care? Need to name a primary care physician (PCP)?

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

You must have a referral to see a specialist or get most other services. Your HMO or medical group must approve many of your services before you can get them. Usually it is your primary doctor who gives you a referral and asks for pre-approval.

However, if you've already got a health plan and don't know which plan type you have, you can check your insurance card or contact your insurance provider directly. If you have an online account through your provider that allows you to access plan details, you can also start there.

Why do people say not to get a Medicare Advantage plan? ›

Restrictive networks

In some cases, you'll have a higher share of costs when you see an out-of-network doctor. In other cases, you're not covered at all if you go out of network. This is particularly important if you travel a lot because Medicare Advantage plans generally don't provide out-of-state coverage.

If you work for a company with fewer than 20 employees, Medicare is considered your primary coverage. That means Medicare pays first, and your employer coverage pays second. If you work for a larger company, your employer-based coverage will be your primary coverage and Medicare your secondary coverage.

About Keystone 65 HMO

Keystone 65 is the largest Medicare Advantage HMO plan in the Philadelphia five-county region to earn 5 out of 5 stars.

This means any plan can be a high deductible health plan — whether it's a preferred provider organization (PPO), health maintenance organization (HMO), point of service (POS) or exclusive provider organization (EPO) plan.

You are required to choose a PCP, or family doctor, to treat your general health needs and coordinate your care. No matter which in-network PCP you choose, your copay will be $0, and you won't need a referral to see a specialist.

A PPO is a type of health plan that offers a larger network. This gives you more doctors and hospitals to choose from. Your out-of-pocket costs are usually higher with a PPO than with an HMO or EPO plan.

However, if you've already got a health plan and don't know which plan type you have, you can check your insurance card or contact your insurance provider directly. If you have an online account through your provider that allows you to access plan details, you can also start there.

Yes, Cigna Open Access Plus (OAP) plans are PPO plans. Is open access a PPO or HMO? PPOs are open access by definition. HMOs can be open access — but open access HMOs are not as flexible as PPOs.

HMOs have lower monthly premiums and lower out-of-pocket costs. For example, there are no deductibles in CalPERS HMO plans. And you won't need to file claim forms when receiving care in the HMO network. Unless it's an emergency, however, HMO plans require you stay within their network for care.