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.
| Go Back | |||
| 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 $8,300 in 2023) | ||
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.