This content is for general informational purposes and does not constitute medical, legal, or financial advice. Healthcare rules and costs change annually. Last reviewed: January 1, 2025. Always verify current details with your insurer, employer, or a licensed healthcare navigator.
HMO (Health Maintenance Organization)
A plan that requires you to use a specific network of doctors and get referrals for specialists.
Full Definition
An HMO requires you to choose a primary care physician (PCP) who coordinates your care. You must get a referral from your PCP to see a specialist. Out-of-network care is generally not covered except in emergencies. HMOs tend to have lower premiums and predictable copays, but less flexibility in choosing providers.
Real-World Example
Your HMO plan's PCP is Dr. Smith. To see a cardiologist, you first visit Dr. Smith, who writes a referral. Seeing a cardiologist directly without a referral means you pay the full cost yourself.
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Top Providers
Companies that offer this plan type. Click any card to visit their official website.
UnitedHealthcare
uhc.com
Largest US health insurer. Offers HMO, PPO, EPO, and HDHP plans through employers and the ACA marketplace.
Blue Cross Blue Shield
bcbs.com
Nationwide network of independent BCBS companies covering all 50 states. Offers HMO, PPO, POS, and HDHP plans.
Aetna (CVS Health)
aetna.com
National insurer offering HMO, PPO, EPO, and HDHP plans through employers and the marketplace.
Cigna Healthcare
cigna.com
Global health services company offering HMO, PPO, EPO, and HDHP plans, with strong international coverage.
Humana
humana.com
Major insurer offering PPO, HMO, and HDHP plans through employers and the marketplace.
Kaiser Permanente
kaiserpermanente.org
Integrated HMO with its own hospitals and doctors across 8 states + D.C. Known for coordinated, affordable care.
Elevance Health (Anthem)
elevancehealth.com
One of the largest BCBS licensees. Offers HMO, PPO, EPO, POS, and HDHP plans across many states.
Oscar Health
hioscar.com
Tech-focused insurer offering HMO and EPO marketplace plans with virtual care and a $0 copay primary care model.
Ambetter (Centene)
ambetterhealth.com
ACA marketplace-focused insurer offering low-cost HMO and EPO plans in many states.
Molina Healthcare
molinahealthcare.com
Specializes in Medicaid and ACA marketplace plans for low- to moderate-income individuals and families.
Plan availability varies by state and employer. Always verify current offerings directly with the provider.
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