HMO Insurance

(Everything you need to know - and more.) Author Icon Written by Trusted Choice Author Icon
Written by Trusted Choice

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Reviewer: Jeffrey Green Reviewed by Jeffrey Green
Reviewer: Jeffrey Green
Reviewed by Jeffrey Green

Jeff Green has held a variety of sales and management roles at life insurance companies, Wall street firms, and distribution organizations over his 40-year career.  He was previously Finra 7,24,66 registered and held life insurance licenses in multiple states. He is a graduate of Stony Brook University.


If you're looking for an HMO insurance definition, you're not alone.  HMOs, or health maintenance organizations, can be confusing if you have never participated in one before. 

Whether you’re choosing health insurance through a group insurance plan or purchasing individual insurance, it’s important to understand how this type of health insurance plan affects your healthcare decisions. 

It’s one of the top forms of health insurance in the nation, but that doesn’t necessarily mean that it’s the right plan for you. 

Don’t make a rash decision when it comes to your health care. Instead, contact an independent agent. Your agent can help you identify the ways an HMO health insurance plan may be beneficial. 

If you decide that HMO insurance is right for you, your agent can then help you compare a variety of policies from multiple insurance companies to find competitive rates and the coverage you need.  

What Is an HMO Insurance Plan?

An HMO medical insurance plan is a form of health insurance that exclusively utilizes a specific network of healthcare providers. The providers have agreed to partner with a specific insurance company to offer medical services at a reduced rate. 

One of the stipulations of an HMO plan is that you’ll be required to choose a primary care physician, also known as a PCP. If you wish to see a specialist, you will need to get a referral from your PCP. The exception to this is OB/GYN doctors.  Female patients can select them along with a PCP.

Is an HMO Health Insurance Plan Right for Me?

If you’re searching for a plan with low premiums and no deductible, this may be the best insurance plan for you, but make sure you read the fine print. HMO health insurance plans come with certain stipulations that help create your low premiums.

Choosing Health Professionals

With an HMO insurance plan, choosing a PCP isn’t necessarily negative, but can be limiting. With this form of health insurance, you must go through your PCP almost any time you need to see another doctor. 

Women are allowed to see an OB/GYN doctor without going through a PCP. If you’re in an emergency situation, you’re also allowed to bypass your PCP. But at any other time, you must have a referral to see a specialist.

Another possible downside is that the specialist you want to see may not be in your network. If this is the case, your services won’t be covered by your health insurance plan, even if your PCP referred you. 

Is HMO Insurance Expensive?

One of the main features of an HMO plan is low upfront costs. Premiums are typically more affordable than any other form of comprehensive health insurance and normally, you have no deductible. This means that you incur no out-of-pocket costs before the health insurance company begins to pay. Another bonus is low co-pays. 

This is the amount that you’re responsible for paying when you visit a doctor’s office for anything other than a routine physical or annual exam. A $20 to $25 co-payment amount is normal.

On the other hand, HMO insurance can be very expensive if you don’t pay attention to your healthcare network. Out of network services aren’t covered at all.

Finding HMO Dental Insurance

Unless you find an HMO insurance plan that includes dental benefits, you may need to seek out a separate dental insurance policy. Just like HMO health insurance, HMO dental insurance plans work on a similar model. 

You can choose a dentist from within a specified network that you can visit for your annual cleanings and other dental work. If you need to see an oral specialist, your primary dentist will need to write a referral. Again, you’ll have no deductible and will not be responsible for filing any claims.

Working with an Agent

While an HMO plan is great for those who are focused on budget-friendly health care, it may not be a wonderful option for people who desire flexibility.

As with other health insurance plans, there are pros and cons, but an agent can help you understand which one will work for your lifestyle. An independent agent can compare HMO insurance quotes and policies to find affordable rates on already-reduced insurance. 

If you want to purchase an HMO insurance plan, contact an independent insurance agent for reliable guidance.

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