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.
HMO
- 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.
PPO
- 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.
References
* Blue Cross Blue Shield Association, Blue Facts (accessed March 2022): bcbs.com.
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and AMGP Georgia Managed Care Company, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Community Care Health Plan of Nevada, Inc. and Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by either Matthew Thornton Health Plan, Inc. or Anthem Health Plans of New Hampshire, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI) underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation. Compcare underwrites or administers HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
CA: Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
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