Health Maintenance Organization

This is a type of Medicare Advantage Plan where you are required to use the physicians and hospitals within your insurer’s network when receiving medical care. As a result, you have to choose a primary care physician (PCP) within the network or else you have to pay for your own care. Exceptions can be made in the event of an emergency. Your PCP will arrange all care with other providers in the network, and referrals are required to see specialists.

As Bill’s physician was not part of the Health Maintenance Organization’s network, he either had to find a new plan or pay for the services of his preferred doctor out of his own pocket.