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HMO Preventive Care for Seniors: An Easy Medical Care Facility

By Charles Hopkins Published 11/2/2006 | Health

Meeting with the medical expenses in their elderly days is becoming increasingly hard. With the costs of medical care skyrocketing day by day, there has been considerable thinking to come up with some plan that will be different from fee-for-service health care providers and replace them with health maintenance organizations (HMO's).

The HMOs were originated as an alternative to a Medigap policy. It provides you with a membership in a health maintenance organization (HMO), or a competitive medical plan (CMP). The health care organizations included in the HMO have contracts with Medicare and provide services to the members of Medicare.

These organizations mainly provide coverage for preventive medicine and health care. Including Medicare, there are few insurance companies that provide coverage for preventive medicine. For example, the Medicare would not cover fees for physical examinations. On the contrary, the HMOs will provide coverage for your regular physical check ups.

As a beneficiary of HMO plan, you receive a number of benefits that are not offered by fee-for-service Medicare. You do not have to pay any additional charges for these benefits. They include such services as extended hospital and skilled nursing facilities, coverage for certain drugs, certain home nursing facilities, etc. In addition, most of the HMO plans provide coverage for services like dental care, hearing testing and hearing aids, and checkups for eyeglasses.

There are a number of reasons why you should consider joining a HMO plan:

l     You get unlimited access to all kinds of preventive medicine.

l     No other insurance company will provide coverage for dental care or routine eye checkup.

l     Through an HMO plan, you become entitled to broader coverage than Medicare and most Medigap insurances.

l     The processing of transactions is far less hassle with HMOs than any other forms of health insurances.

l     By joining a HMO, the whole organization becomes responsible for your well-being. In the case of other insurances, you are under the supervision of an individual practitioner. Naturally, you receive better care from HMO plan.

You have to fulfill certain requirements for being covered by HMO plan.

l     You have to continue with Medicare's medical insurance (Part B) by paying regular premiums.

l     You should live within the area specified by the HMO. This is the area where the particular HMO provides its services.

l     An HMO does not entitle you to get care in emergency or urgent situations.

l     If you are a patient with chronic kidney disease, you cannot enroll in an HMO as a new member. If you develop such a disease when you are already a member of an HMO, then you are entitled to receive all kinds of necessary care through the organization.

l     It is not possible to enroll in an HMO as long as you continue with your option of hospice care. You can elect hospice care if you are already a member of an HMO and continue in the organization's plan. In that situation, all care expenses related to the terminal diseases will be met by the hospice, and not the HMO.

It is not mandatory to carry on with any HMO plan. You can drop the HMO in any month and return to regular Medicare at the beginning of the next month. You have to keep Medicare informed about the change. Make sure to buy some temporary or supplementary health insurance before the change takes place.