HMO Insurance: Health Maintenance Organization
Avg. premium: $440/mo | Deductible: $1,800
What Is HMO Insurance?
An HMO plan requires you to choose a primary care physician (PCP) who coordinates your care and provides referrals to specialists. You must use in-network providers except in emergencies.
Monthly Premium
$440
Deductible
$1,800
Copay
$20-$40 per visit
Flexibility
Low
Who Is HMO Best For?
People who want lower premiums and don't mind staying in-network with a PCP coordinating care.
Pros and Cons
Advantages
- Lower monthly premiums
- Lower out-of-pocket costs
- Predictable copays
- Coordinated care through PCP
- No claim forms for in-network care
Disadvantages
- Must use in-network providers
- Need referrals to see specialists
- No out-of-network coverage (except emergencies)
- Less flexibility in choosing doctors
- May need to switch doctors if they leave the network
Key Features
Referrals RequiredYes
Out-of-Network CoverageNo (except emergencies)
Network FlexibilityLow
Family Premium$1,250/mo