Got questions on Medicare Health Maintenance Organizations (HMOs), or clients with questions? One resource is the newly revised version of California’s HMO Guide for Seniors, published by the Office of the Patient Advocate (OPA). Available in English and Spanish, this Guide explains what a Medicare HMO is and how they work. It provides tips on how to choose a doctor and encourages beneficiaries to learn about different treatment options. Additionally, it describes enrollees’ rights if they’re denied care, access rights for people with disabilities and available language services for people who don’t speak English.
Sections in the Guide include:
- What HMOs are, and how to join and leave a plan;
- How to choose a doctor;
- Your covered benefits in an HMO and how to use/access them; and
- Where to go for help with appeals, customer service complaints and quality of care issues.
California Health Advocates reviewed and provided comments for the new revised Guide as a statewide HEROIC (HMO Enrollee Regional Outreach & Information Center) project. The HEROIC program is part of the OPA’s mission “to inform and educate consumers about their rights and responsibilities as health plan enrollees and to teach them how to make the best use of the services offered by their health plans.” The HMO Guide for Seniors was produced by UC Berkeley in collaboration with the OPA and California Health Advocates.
For free copies of this guide, email Jasmine Suo, our Operations Manager at
. Let her know if you’d like the English or Spanish version.
People with visual impairments can download the older version of the guide in a screen reader text format in English (click here and scroll to the bottom of the page). Note: the new version is not yet posted online.
For more information on Medicare HMOs and other Medicare Advantage plans, see our website section, Medicare Advantage.