Management Option #2: Find the Right Insurance Plan

Health Maintenance Organization (HMO)
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Health Maintenance Organization (HMO)
The various healthcare insurance plans for patients` needs are either categorized as those that restrict provider choices or encourage the patients to receive the care for doctors, pharmacies, hospitals as well as other medical providers. In other cases, the insurance pays high costs for the providers that are outside the network of the plan. The examples of Medicare Advantage Plans available for clients include preferred provider Organization (PPO), Health Maintenance Organization (HMO) and Private Fee For Service (PFFS) among others. Some of the patients' needs may include the need for primary care, preventive care, and wellness or dental care. Therefore, the HMO is a Medicare Advantage plan or insurance plans that are offered by the private health entities under the approval of the Medicare. The HMO under the law is required to offer similar benefits of the Original Medicare besides other additional coverage such as dental benefits, health wellness programs and prescription drugs. Based on the need for dental care and the entire family wellness, the HMO is essentially crucial since it offers such plans besides providing accessibility to doctors, hospitals and other health care providers so long as one accepts Medicare.
Insurance Chart
Medicare Advantage PlanPreferred provider Organization Plan (PPO)Health Maintenance Organization (HMO)Private Fee For Service Plan (PFFS)Medicare Part A, Part B, Part C and Part DClients choose their own doctors, hospitals and other services within its networkClients receive care outside the network but with high out of pocket feeNo primary care provider as a requirement Clients choose their own doctors, hospitals and other services within its network under restricted guidelines.Clients may receive care outside the network but has full responsibility for the cost (except emergency cases)Primary care provider is a requirement for referralAllows client to visit any doctor or hospitals provided the terms and conditions for payment are accepted by the provider whether provider contract with the plan at each time of visit
Important Features for the HMO choice
Eligibility: The eligibility for the Medicare HMO plan requires that a person should have Medicare Part A and Part B besides livin in the area where the services are provided and have no End-Stage Renal Disease (ESRD) at the time of enrollment (Tajeu, 2014). In addition, HMO services are specific hence a person has to live within the plan’s area of service. Furthermore, it has specific networks of doctors and providers within the same area of service. However, if any person seeks for services outside the network, an extra expense has to be incurred which is considerably high. Such extra costs are not paid by the HMO insurers (Tajeu, 2014).
Patients who are diagnosed with the kidney failure or (ESRD) are not allowed to access the HMO plan. However, the patients who are members of the HMO and later are diagnosed with ESRD can either keep their HMO coverage if they choose to or may opt out (Tajeu, 2014). In other cases, patients who have successful kidney transplant may join the HMO insurance plan. In add...