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Medicare Advantage HMO Plan

Lower-cost network style plan that usually requires in-network care and may require referrals.

Talk to a Licensed Agent: (302) 407-0876

A Medicare Advantage HMO (Health Maintenance Organization) plan is a lower-cost network style plan that usually requires in-network care and may require referrals. It's one of the most common Medicare Advantage plan structures, and it tends to fit people who are comfortable using a local network of doctors in exchange for more predictable costs.

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How an HMO Plan Works

With an HMO plan, you typically choose a primary care doctor from the plan's network. That doctor coordinates your care and, for most HMO plans, provides referrals when you need to see a specialist. Care received outside the plan's network usually isn't covered except in an emergency.

Why People Choose HMO Plans

HMO plans often come with lower monthly premiums and lower out-of-pocket costs than plans with broader network access. The trade-off is less flexibility — if keeping a wide choice of providers matters more to you than cost, it's worth comparing an HMO against a PPO plan.

Who an HMO Plan Might Fit

An HMO plan often fits people who are comfortable staying within a defined network, who want a more coordinated care experience with a primary care doctor managing referrals, and who want to keep monthly costs and copays as predictable as possible.

Frequently Asked Questions

Generally no. HMO plans usually require you to use doctors and hospitals in the plan's network, except in emergencies.