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Health Maintenance Organization
(HMO) Plan

In many HMO Plans, you can only go to doctors, other health care providers, or hospitals on the plan's list except in an emergency. You may also need to get a referral from your primary specialist. Find and compare HMO Plans in your area.

Will I be getting my prescription drugs?

Many of the HMO plans cover prescription drugs. A few plans may have different rules and regulations. In case you do not have prescription drug coverage from another plan, you will need to chose an HMO plan with Medicare Prescription drug coverage (Part D). You will pay a penalty if you do not have Part D or other credible prescription drug coverage for any continuous period of 63 days or more after you become eligible.

Can I pick my primary care doctor?

Many of the HMO plans allow you to pick your primary healthcare doctor present in their network.

Do I need a referral to visit a specialist?

Many of the HMO plans need referrals for you to visit the specialist.

Any other valuable information you should know before enrolling in HMO Plans?

  • If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another doctor in the plan.
  • If you get health care outside the plan's network, you may have to pay the full cost.
  • It's important that you follow the plan's rules, like getting prior approval for a certain service when needed.
  • Before you enroll in a plan, check to see whether your doctors are included.