HMO Option

Health Maintenance Organization Plans (HMOs) Offer Greater Affordability but Within a Network.

When you have an HMO plan, you generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network except in an emergency. Otherwise you may have to pay the full cost.  Some plans may let you go out-of-network for certain services, usually for a higher cost. This is called an HMO with a point-of-service (POS) option.

HMO Plans May Offer a Prescription Drugs Coverage Component

If you want Medicare prescription drug coverage (Part D), you must join an HMO Plan that offers prescription drug coverage.

You’ll need to choose a primary care doctor and get a referral to see a specialist.

However, certain services, like yearly screening mammograms, don’t require a referral.

If your doctor leaves the plan, your HMO will let you know.

You can then choose another doctor in the plan.  When you have an HMO, it’s important to follow the plan’s rules, including getting prior approval for a certain service when needed.