What is an HMO plan?
On a health maintenance organization (HMO) plan, covered services must be provided or authorized by the member’s primary care physician and received from plan (in-network) providers. A referral must be obtained prior to receiving care from specialty providers except for in-network gynecological and obstetrical visits for women and routine eye examinations. Services provided by non-plan (out-of-network) providers are not covered except for emergency care and urgent care. On an HMO plan, the member is responsible for a copayment and/or coinsurance for services received. copayment and coinsurance amounts for specific services are listed in the Benefit Summary for your plan.
An HMO refers to a Health Maintenance Organization. Under an HMO, you must choose a primary care physician (PCP) from within the HMO’s provider network. You will then go to your PCP for all your medical needs. You will need to get a referral from your PCP to see a specialist doctor. If you go to an out-of-network provider or fail to get a referral from your PCP for any services, you may be responsible for the entire bill. The only exception is for emergency care. HMO’s are the least flexible in terms of who you can see, but they typically cost less and provide lower deductibles and lower out-of-pocket costs. You can get additional information about HMO’s from the State of Michigan’s Department of Labor & Economic Growth’s HMO Page.
Related Questions
- Why are the co-pays higher in the POS plan, while I am already paying a higher premium than similarly situated individuals in the HMO?
- My plan is a health-maintenance organization (HMO). How do I select a primary-care provider (PCP)?
- How can Choices 65 (HMO) give me so much coverage without charging me a monthly plan premium?
