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Medicare Advantage HMO Program Criteria

The Medicare Advantage program allows Medicare beneficiaries to receive their health benefits through private health plans, primarily health maintenance organizations (HMOs), rather than the fee-for-service Medicare program administered by the federal government. The criteria for qualifying for Medicare Advantage is the same as the other parts of Medicare.

  1. Features

    • Medicare Advantage plans provide all Medicare-covered health care through the private plan selected by the enrollee. These plans include Medicare HMOs, Preferred Provider Organizations (PPO), Private Fee-for-Service Plans and Medicare Special Needs Plans.

    Eligibility

    • If you are 65 or older, a citizen or permanent resident of the United States, and if you or your spouse worked for a minimum of 10 years in Medicare-covered employment, you qualify for Medicare Advantage.

    Considerations

    • Proponents of Medicare Advantage argue that the private health options provide more choice and lower costs. The Medicare Payment Advisory Commission reported in 2010 that the Medicare Advantage HMOs, which serve 15 percent of all seniors in the Medicare program, costs 2 percent less than the same benefits under traditional Medicare.

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