Medicare Advantage HMO plans have strict rules for Medicare beneficiaries. You must play by their rules or else your claim is not covered. This is a summary of the HMO rulebook.
- You can only obtain care from an HMO approved doctor, hospital, lab or other participating medical provider
- Your Advantage HMO will only pay for a specialist if you have a referral from your HMO PCP (primary care provider)
- Some medical procedures require prior written approval from the HMO before they will be covered
- You have limited rights of appeal if your HMO claim is denied
Bob Vineyard and Georgia Medicare Plans does not recommend Advantage HMO plans to our clients. We believe the choice and value from GA Medigap plans is superior to those offered by HMO plans.