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Member FAQ

Memorial Hermann Advantage HMO Member - Frequently Asked Questions

Once you have enrolled in the Memorial Hermann Advantage HMO plan and we have approved your enrollment through Centers for Medicare & Medicaid Services, you will typically receive your Memorial Hermann Advantage HMO membership ID card within 10 days of your effective date.

Memorial Hermann Advantage HMO covers the same benefits you receive in Original Medicare, as well as additional health benefits like prescription drug coverage, a $0 PCP office co-pays, $0 Part C plan premium, dental benefits, hearing and vision allowances, fitness benefit, a 24/7 Nurse Hotline and more. You are required to use doctors and other health care providers within the Memorial Hermann Advantage Network.

Learn more about the Memorial Hermann Advantage HMO plan and what it covers.

When you are outside the service area and cannot access care from a network provider, our HMO plan will cover urgently needed care that you receive from any provider. In addition, our plan offers coverage for emergency care worldwide whenever you need it. Members are only responsible for the emergency room and or Urgent Care copays. If you are hospitalized, your copay will be refunded.

Memorial Hermann Advantage HMO does not provide coverage for out-of-network general/routine care services. All costs for these services will be the responsibility of the member.

Urgently needed care is a non-emergency, unforeseen medical illness, injury or condition that requires immediate medical care. Urgently needed care may be furnished by in-network providers or by out-of-network providers when network providers are temporarily unavailable or inaccessible. The unforeseen condition could, for example, be an unforeseen flare-up of a known condition you have.

For Memorial Hermann Advantage HMO, if it is not urgent/emergent services then you are responsible for all costs.

Yes, the plan will pay for covered urgent/emergent care, or renal dialysis. However, you will be responsible for your bill at the time of service, but you may then submit your bill to the Plan for reimbursement minus your copay.

Once you have reached your maximum out-of-pocket costs, you stop paying out of pocket for all covered services except the services with benefit maximums (i.e. hearing aids, eyewear, SNF, and outpatient rehab services).

No, in that circumstance the ER copay is waived when you are admitted to the hospital within 48 hours of the ER visit and you would only be responsible for the inpatient hospital copay amount.

You will also receive a discount on brand-name drugs and generally pay no more than 25% for the plan's costs for brand drugs and 25% of the plan's costs for any generic drugs. Until your yearly out-of-pocket drug costs reach $6,350.

After your total yearly drug costs reach $6,350, you will pay $3.60 for generic drugs and $8.95 for brand drugs or 5% coinsurance for these drugs whichever amount is greater.

Memorial Hermann Advantage HMO plan will pay up to $400 every year toward the cost of hearing aids. You pay no copay. If the cost of the hearing aids is greater than the maximum allowance every year paid by the plan, you will be responsible for the remaining cost.

Memorial Hermann Advantage HMO plan will pay up to $200 every year toward the cost of eyewear.

Our service area includes Harris, Fort Bend and Montgomery counties. That means all members must live in one of those 3 counties to be eligible for our plan. Our provider network is not limited to these 3 counties, as any provider or hospital that is in our network, anywhere in Greater Houston is "in the network."

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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