Is HMO Coverage for Me?

At Cambridge Medical Group, we accept most traditional insurance plans, in addition to select Medicare Advantage (HMO) programs. Seniors experiencing the increased financial burden of copays, deductibles, premiums and out of pocket prescription drug costs are concerned when they see how much of their discretionary budget must go to medical costs. They often ask us about Humana’s Gold Plus Plan and other HMO’s.

Medicare Advantage Plans often offer patients significantly lowered out of pocket costs, but they’re not for everyone. If you’re the type of patient who prefers to self-diagnose and self-refer to specialists and other ancillary providers or if you spend large blocks of time out of the area, you would probably be happier in a traditional insurance plan, despite the increased costs.

However, if you recognize the value of developing a sound working relationship with your primary care physician and desire the benefits of a “Medical Home” where all specialist, hospital, lab and prescription information can be reviewed by your personal physician, a Medicare Advantage plan is certainly worth considering.

At Cambridge, we strive to engage our patients and their families in their health care decisions. We will not contract with any Medicare Advantage Plan that does not share that vision; nor do we accept any Plan that dictates which specialists and hospitals we may use. From labs to diagnostics to specialists to hospitals- we screen our referral providers for quality, customer care and patient satisfaction – and we use the same panels for our patients regardless of whether they have indemnity or HMO coverage. Chances are, your current specialists are already in our network.

In the end, we believe Medicare Advantage enables us to provide comprehensive care to those Medicare patients willing to become active participants in their care planning. The reasons for this are simple: Better Coordination; Better Benefits; Better Care. In a Medicare Advantage Plan we have instant access to referral reports, hospital discharge summaries and prescriptions. This enables us to maintain a complete picture of your health and care in real time; advantages that are not always available through traditional insurance.

Many unnecessary hospitalizations seniors) be avoided if there were one professional coordinating all of the specialists and facilities issuing prescriptions, lab tests and diagnostics. If that professional is not your primary care physician, then you are essentially playing “doctor” with your own health.

So, while Medicare Advantage Plans are not the answer for all of our patients, they do offer significant financial and health advantages to some; plus the opportunity to involve yourself as part of a team in managing your own health.

If you’d like more information on any of the insurance or Medicare Advantage Plans we accept, please don’t hesitate to ask any of our staff.