What must be explained to consumers when enrolling in an HMO health maintenance organization MA plan?

When enrolling in a health maintenance organization (HMO) Medicare Advantage (MA) plan, a key point that must be explained to consumers is that they must see contracted in-network providers for coverage.

This is essential because HMO plans are structured to provide services through a network of providers, and typically, care received from out-of-network providers is not covered, except in emergencies. This means that for the plan to provide benefits, consumers must select a primary care provider from the network and obtain referrals to see specialists within the same network. This approach aims to promote coordinated care and control costs, benefiting both the insurer and the member through preventive care and management of medical services. Understanding this requirement helps consumers make informed choices about their healthcare options and plan enrollment.