Understanding HMO Health Coverage Plans

What Is An HMO?


An HMO, or Health Maintenance Organization, is a plan made up of a network of doctors, hospitals, and other healthcare providers who have agreed to set rates for services. While members who choose an HMO may be limited to certain doctors and hospitals, they may pay less for healthcare than they would with other health insurance plans.

What Is The Difference Between An HMO And A PPO?


Plan cost and the size of the plan network are the two main differences between an HMO and a PPO. Compare the two types of plans to see which one is a better fit for your healthcare needs.



  • Lower monthly premiums
  • Lower out-of-pocket costs for in-network providers 
  • Only in-network providers and emergency and urgent care visits are covered. You also may need to select your primary care physician from the network. 


  • Higher monthly premiums
  • Lower out-of-pocket costs for in-network providers
  • More in-network provider options. Out-of-network care is accepted, but costs more.



What Are The Benefits Of An HMO?


Here are some of the key things to know about an HMO:


Lower premiums. You typically pay less for monthly premiums to cover yourself and your family. You also pay less in out-of-pocket costs if you stay within the network. Plus, HMO plans have low deductibles.


A selected primary care physician. The doctor you choose is responsible for managing the treatment and care of you and your family. This professional will also advocate for services on your behalf.


Select provider network. You’ll get more out of an HMO insurance plan and save money by selecting doctors in the plan’s network. You can only receive care out of network if it’s a medical emergency or urgent care visit in most states.



Is An HMO Right For You?


If you want lower healthcare premiums and are comfortable visiting a PCP for your care needs, an HMO might be right for you and your budget. Before applying, be sure to check that your preferred doctor and hospital are in network. Anthem's national network includes 1.7 million doctors and hospitals — more than any other insurer.*


Compare costs of HMO plans with other types of coverage to see what fits your budget.



Get Help Navigating Your Healthcare Journey


Count on our experience and support to enroll in health coverage. We can help you choose health coverage with Anthem and guide you through the process.




* Blue Cross Blue Shield Association, Blue Facts (accessed March 2022): bcbs.com.



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