Does having a Medicare HMOs really mean you give up your Medicare Part B benefits?

Question

My grandparents are getting bills from a doctor's office saying that my grandparents no longer have Medicare benefits since they have a Senior HMO. By having a Medicare HMO, the doctor's office is saying that my grandparents have gaveup their Medicare benefits. Is this true?

Answer 1

Your grandparents are still on Medicare. A Medicare HMO is an HMO that has contracted with the federal government under the Medicare Advantage program (formerly called Medicare+ Choice) to provide health benefits to persons eligible for Medicare that choose to enroll in the HMO, instead of receiving their benefits and care through the traditional fee for service Medicare program.

They are receiving bills from their doctor probably because that doctor is not part of the HMO they joined.

There is an organization called the Medicare Rights Center. According to them, a Medicare HMO will only let you see certain doctors or hospitals within your area unless you have an emergency. These doctors and hospitals are part of what is called the HMO’s network. You must choose a primary care physician (PCP) from the network. That doctor decides when you can see a specialist.

You can get all your Medicare benefits, including drug coverage, through a Medicare HMO. Medicare HMOs must cover the same kinds of care that Original Medicare covers, but they decide when you need it. They may also offer additional benefits like:

Dental care
Eyeglasses and vision care
Hearing aids
Physical exams

Starting in 2006 you will be limited in the number of times and when you can switch HMOs or go back to Original Medicare. You are only allowed to make one Medicare health plan change–either to a private Medicare health plan or to Original Medicare–from January 1 through June 31, 2006. From July through the remainder of the year, you will be "locked in" to whatever health plan you chose. You can change your selection for the following year (coverage to start January 1) between November 15 and December 31 of every year.

If you wish to return to Original Medicare, tell your HMO or your local Social Security office *in writing* that you want to leave and return to Original Medicare. Keep a copy of your letter for yourself. You will be back in Original Medicare one to two months after you disenroll.

To switch to another Medicare HMO, just sign up. You will be automatically disenrolled from your current HMO when your new coverage begins. You should check with your new HMO to find out when coverage begins.

I hope this is helpful. Check out the link below.

Answer 2

Ithink so, as Medicare is more like Medi-scare sometimes... but I do know that if you have a Medicare HMO, that it's not the same as Medicare part B.
Unfortunately when people sign up for these things, they are not told about the differences.
I have a patient w/ a Medicare HMO that did not pay for any of her care as I am not in that network... so she got stuck with the entire bill.
Had she just had plain old Medicare, it would have been covered & she would have only had to pay $7.14 per visit.
This may be the case with your grandparents.
Have them go to the local place where they initially signed up for Medicare & ask about the differences & perhaps they can get off the HMO & back on Part B- maybe they thought they were saving money, but if they are going to a lot of doctors who are not in the HMO, and it costs them more in the end, it may be worth going back to a regular Medicare plan...

They (or you or your parents) could also call the customer service phone number on the HMO card--- be warned you will probably be on hold for a while, and make sure you document who you talk to.
Keep records of this. It may take a few phone calls to figure it out.