Health Maintenance Organization

An HMO, or Health Maintenance Organization, is designed to keep costs low and predictable. With one doctor to coordinate your care, an HMO health plan is easy to use and may be just what you’re looking for. An HMO health plan offers:

  • Monthly premiums, copays and deductibles are often lower than other types of plans.
  • Access to certain doctors and hospitals, called your HMO provider network, which helps control how much you pay for health care.
  • A primary care physician (PCP) who you see for routine check-ups, physicals, colds and flu. Your PCP will refer you to a specialist for more serious illnesses.
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Pros and Cons of Health Maintenance Organizations (HMOs)

An HMO health plan is care personalized to meet your needs. Your primary care doctor, or PCP, gets to know you, your health history and your family’s health history and how it may affect your health. Think of them as your personal care doctor.

PCPs can be doctors who practice:
  • Family medicine
  • OB/GYN
  • Geriatrics
Out of Network Services
  • Emergency care
  • Out-of-area urgent care

Are prescription drugs covered in Health Maintenance Organization (HMO) Plans? In most cases, prescription drugs are covered in HMO Plans.  If you want Medicare drug coverage (Part D), you must join an HMO Plan that offers prescription drug coverage. Ask an Agent! If you join an HMO plan without drug coverage, you can’t join a separate Medicare drug plan.

Do I need to choose a primary care doctor in Health Maintenance Organization (HMO) Plans?

In most cases, yes, you need to choose a primary care doctor in HMO Plans.

Do I have to get a referral to see a specialist in Health Maintenance Organization (HMO) Plans?

In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don’t require a referral.