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What is an HMO?

HMO stands for Health Maintenance Organization. With an HMO plan, you must choose a Primary Care Physician (PCP) from a network of local healthcare providers who will refer you to in-network specialists or hospitals when necessary. All your care is coordinated through that PCP.

For example, if you suffer from back pain, you would first visit your PCP. If they can’t help you, they will provide you with a referral to a trusted, in-network specialist who can. An important thing to keep in mind about HMO plans is that they generally won't cover out-of-network care except in a true emergency.

Is an HMO plan right for me?

There are several factors to take into account when choosing whether an HMO plan is the right option for you and your family. Some key things to consider are:

Lower Cost

With an HMO plan, your out-of-pocket medical costs and monthly premiums will generally be lower than with other types of plans. If you are someone who doesn’t see a lot of specialists or would like having your care coordinated through a PCP, then you might save more money with an HMO plan.

Find out more about Humana’s HMO plans - click Quote now to see price and coverage details for plans in your area.

Selecting a Primary Care Physician (PCP)

When you apply for an HMO plan, you’ll select a Primary Care Physician who will be the first point of contact for your healthcare. You are encouraged to build a strong relationship with your PCP because they will connect you to specialists or other health care providers. Your PCP will be able to see the total picture of your overall health. Together you can make the best decisions to manage your health and well-being, which includes your PCP making referrals to specialists.

To find a PCP in your area, visit Humana’s easy-to-use Finder Tool.

If you have a standing relationship with a doctor or specialist outside of your network, or would prefer more flexibility when choosing your care providers, you might consider a Preferred Provider Organization (PPO) plan instead. PPO plans often feature a higher monthly premium and out-of-pocket medical costs but will allow you the freedom to choose doctors and specialists that are in- or out-of-network without a referral from a PCP.

Interested in an HMO plan and over 65?

If you are eligible for Medicare and looking for an HMO, find out more about the Humana Gold Plus (HMO) plan.

HMO options for employers

Are you a business looking to offer HMO plans to your employees?

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With an array of insurance options and extras, Humana lets you build a personalized plan to fit your life, budget, and family.

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