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1.   What is the difference in Traditional Medicare and an HMO replacement plan?

If you are on Home Health, the aide that comes to visit may only be able to see you for a limited number of times.

Only if your doctor accepts the HMO you sign up with, otherwise you must go to a different doctor.

If it is an emergency yes, otherwise you will have to find a hospital or skilled nursing facility or long term care facility that accepts your HMO.

4.   Does an HMO limit the care I get?

The Main Difference is this: A Medicare Advantage Private Fee-for-Service plan or HMO is NOT A MEDICARE SUPPLEMENT PLAN.  Your Doctor or hospital is not required to agree to accept the plan's terms and conditions, and thus may choose not to treat you, with the exception of emergencies which means you may have to drive to Houston to see a doctor or be treated in a hospital.  If your doctor or hospital does not agree to accept the HMO's payment terms and conditions, or otherwise agree to treat you, you will not be able to receive covered services from them under this plan.

What is an HSA?

A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP).  The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), HSA funds roll over and accumulate year to year if they are not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds paired with either HDHPs or standard health plans.

HSA funds may currently be used to pay for qualified medical expenses at any time without federal tax liability or penalty. Beginning in early 2011 over-the-counter medications cannot be paid with an HSA without a doctor's prescription.  Withdrawals for non-medical expenses are treated very similarly to those in an individual retirement account (IRA) in that they may provide tax advantages if taken after retirement age, and they incur penalties if taken earlier. The accounts are a component of consumer-driven health care.

Specializing in the care of Digestive Disorders since 2006

6.   If I signed up with an HMO, but I want to switch back to Traditional Medicare, what do I do?

Traditional or Original Medicare Plan is a fee-for-service plan managed by the Federal Government.  In general, with the Original Medicare Plan:

  • You use your red, white and blue Medicare card when you get health care.
  • You can go to any doctor or supplier that accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
  • You pay a set amount for your health care (a deductible) before Medicare pays its part.  Then, Medicare pays its share and you pay your share (your coinsurance or copayment) for covered services.

5.   How for example?

It can. Because HMO's are privately owned, they set the rules for your care.  Last year, HMO's profited 16 Billion Dollars...yes Billion.

2.    So with an HMO can I go to my regular doctor?

MEDICARE AND HMO

Frequently Asked Questions

HEALTH SAVINGS ACCOUNT

An HMO replacement plan is a type of Medicare Health Plan that is available in most areas of the country.  They are run by private companies.  Plans must cover all Medicare Part A and Part B health care.  In most HMOs, you can only go to doctors, specialists or hospitals on the plan's list except in an emergency.

3.   Can I go to my local hospital?

  • Call 1-800-633-4227 (1-800-MEDICARE)
  • Tell them you want to change back to traditional Medicare.
  • Call the HMO and tell them you are cancelling with their service.  If possible, send them a letter.