What do I do if my Medicare HMO goes out of business?

By Insurance.com Posted : 01/01/2011

If the private insurance company operating the HMO plan decides not to participate in Medicare, then you need to enroll in another Medicare Advantage plan or switch to Original Medicare.

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A Medicare Advantage Plan, also known as Medicare Part C, is a Medicare health insurance option that covers hospital treatment as well as outpatient medical services, such as doctors visits. Most plans also cover prescription drugs, and some cover vision, hearing, dental and wellness programs.

Private companies that are approved by Medicare offer the plans. Some Medicare Advantage Plans operate like a health maintenance organization, and some operate like a preferred provider organization. Usually you enroll in a plan one year at a time.

Your other option is to choose Original Medicare, also known as Parts A and B. Part A covers hospitalization, and Part B covers other medical services, including preventive services. You can also opt for Part D, which covers prescription drugs. Most people qualify for Part A, the hospital coverage, for free because they paid taxes toward Medicare while working. To get Part B and Part D, you pay a monthly premium.

You should also consider supplemental insurance, known as Medigap, to cover the portion of medical bills, such as coinsurance and deductibles, that Original Medicare doesn't cover.

The big plus of a Medicare Advantage plan is it's usually lower than the cost of supplemental insurance. However, Medicare Advantage plans come with restrictions on which doctors and hospitals you can use.

Shop around and compare plans if you decide to go with Medicare Advantage. The plans vary in how they operate and in the premiums, deductibles, copayments and coinsurance you pay. All Medicare Advantage Plans must cover the services Original Medicare covers, except for hospice care. Research plans that are offered in your area to find the most affordable option that suits your needs. Make sure the plan's network includes the hospitals and doctors you use.

Search for plans with the government's online Medicare plan finder tool. After you enter your ZIP code and other pertinent information, you can see a list of plans available in your area. Medicare also provides one- to five-star quality ratings for plans. Select the plan name, or choose up to three plans to compare to view quality ratings.

For more about Medicare enrollment, see "Call waiting: Guide to helping parents with Medicare open enrollment."

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