A Health Maintenance Organization (HMO) plan is a type of healthcare plan that limits coverage to care from doctors, hospitals, and healthcare facilities that work for or contract with the HMO. You may be required to live or work in the HMO service area in order to receive coverage.
HMO plans cover services rendered by providers that are in-network (for a certain geographic area) ONLY. Out-of-network care is not covered except during an emergency. All of your healthcare is coordinated by a Primary Care Physician (PCP), meaning that your PCP will refer you to an in-network specialist in the event that you need integrated care.
With an HMO plan, you can expect to pay a lower monthly premium than you would for other plan types. Additionally, your deductible and other out-of-pocket expenses will likely be lower than other healthcare plans. For some HMO plans, you may not owe anything for care received during a hospital stay once you’ve met your deductible.
The Open Enrollment Period for 2019 coverage may still be open in your area. Click here to explore your options.
HMOs offer the lowest monthly premiums and still offer low deductibles.
Your service provider works with the insurance company directly, so you don’t have to file any claims.
Prescription drug costs are kept low, especially for generic drugs.
Coverage will only be provided for services received by in-network providers.
HMO providers are split by geographic area. You may not have always have access to healthcare providers you want.
A referral is required by your PCP in order to see a specialist.
There are several other healthcare plans available to meet your needs: Check out these plan types for more information: Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), and Point of Service (POS)
Perfect for people who prioritize choice and flexibility. Premiums are higher than other plan types but you’ll have coverage for more care providers.Learn more »
Great for people who are conscious of their budget as they often offer lower premiums and cost sharing than PPOs. However, there’s no coverage for out of network care.Learn more »
POS plans are similar to HMO plans but offer the increased flexibility of providing coverage for care costs outside of the network.Learn more »