A health maintenance organization (HMO) gives you access to a network of doctors and hospitals that you must use in most cases. Most HMO plans require you to get a referral from a primary care physician for hospital care and specialist visits. There are typically limited out-of-network benefits with an HMO plan.
|
Our HMO plans |
Our HMO-POS plans |
Our PPO plans |
|
|---|---|---|---|
|
Requires you to use a provider network |
Yes, unless it’s an emergency |
No. But seeing out-of-network providers generally costs more. |
No. But seeing out-of-network providers generally costs more. |
|
Requires you to have a Primary Care Physician (PCP) |
Most plans |
Some plans |
No PCP required |
|
Requires referral to see a specialist |
Most plans |
Some plans |
No referral required |
|
Monthly premiums |
Varies by plan from $0-$178 |
Varies by plan from $0-$33 |
Varies by plan from |
|
Medical deductible |
Varies by plan from $0-$1,180 |
Varies by plan from $0-$500 |
Varies by plan from |
|
Limits what you pay out-of-pocket for medical care each year |
Yes |
Yes |
Yes |
|
Includes prescription drug (Rx) coverage |
Yes, in most plans |
Yes |
Yes, in most plans |
|
Includes Rx mail-order benefit |
Yes, if plan has Rx coverage |
Yes |
Yes, if plan has Rx coverage |
|
Dental, vision and hearing coverage |
Yes, in most plans |
Yes, in most plans |
Yes, in most plans |
|
ER and urgent care coverage worldwide |
Yes |
Yes |
Yes |
|
Fitness benefit |
Yes, through SilverSneakers® |
Yes, through SilverSneakers® |
Yes, through SilverSneakers® |
|
Over-the-counter (OTC) benefit (get select OTC items at no charge) |
Yes, in most plans |
Yes |
Yes, in most plans |
|
Transportation benefit (trips to things like doctor appointments) |
Available in some plans |
Available in some plans |
Available in some plans |
|
Meals-at-home program |
Available in some plans |
Available in some plans |
Available in some plans |
|
Our HMO plans |
|
|---|---|
|
Requires you to use a provider network |
Yes, unless it’s an emergency |
|
Requires you to have a Primary Care Physician (PCP) |
Most plans |
|
Requires referral to see a specialist |
Most plans |
|
Monthly premiums |
Varies by plan from $0-$178 |
|
Medical deductible |
Varies by plan from $0-$1,180 |
|
Limits what you pay out-of-pocket for medical care each year |
Yes |
|
Includes prescription drug (Rx) coverage |
Yes, in most plans |
|
Includes Rx mail-order benefit |
Yes, if plan has Rx coverage |
|
Dental, vision and hearing coverage |
Yes, in most plans |
|
ER and urgent care coverage worldwide |
Yes |
|
Fitness benefit |
Yes, through SilverSneakers® |
|
Over-the-counter (OTC) benefit (get select OTC items at no charge) |
Yes, in most plans |
|
Transportation benefit (trips to things like doctor appointments) |
Available in some plans |
|
Meals-at-home program |
Available in some plans |
|
Our HMO-POS plans |
|
|---|---|
|
Requires you to use a provider network |
No. But seeing out-of-network providers generally costs more. |
|
Requires you to have a Primary Care Physician (PCP) |
Some plans |
|
Requires referral to see a specialist |
Some plans |
|
Monthly premiums |
Varies by plan from $0-$33 |
|
Medical deductible |
Varies by plan from $0-$500 |
|
Limits what you pay out-of-pocket for medical care each year |
Yes |
|
Includes prescription drug (Rx) coverage |
Yes |
|
Includes Rx mail-order benefit |
Yes |
|
Dental, vision and hearing coverage |
Yes, in most plans |
|
ER and urgent care coverage worldwide |
Yes |
|
Fitness benefit |
Yes, through SilverSneakers® |
|
Over-the-counter (OTC) benefit (get select OTC items at no charge) |
Yes |
|
Transportation benefit (trips to things like doctor appointments) |
Available in some plans |
|
Meals-at-home program |
Available in some plans |
|
Our PPO plans |
|
|---|---|
|
Requires you to use a provider network |
No. But seeing out-of-network providers generally costs more. |
|
Requires you to have a Primary Care Physician (PCP) |
No PCP required |
|
Requires referral to see a specialist |
No referral required |
|
Monthly premiums |
Varies by plan from |
|
Medical deductible |
Varies by plan from |
|
Limits what you pay out-of-pocket for medical care each year |
Yes |
|
Includes prescription drug (Rx) coverage |
Yes, in most plans |
|
Includes Rx mail-order benefit |
Yes, if plan has Rx coverage |
|
Dental, vision and hearing coverage |
Yes, in most plans |
|
ER and urgent care coverage worldwide |
Yes |
|
Fitness benefit |
Yes, through SilverSneakers® |
|
Over-the-counter (OTC) benefit (get select OTC items at no charge) |
Yes, in most plans |
|
Transportation benefit (trips to things like doctor appointments) |
Available in some plans |
|
Meals-at-home program |
Available in some plans |
In addition to HMO plans, ${company} offers you other Medicare Advantage plan options — many with a $0 monthly plan premium. We can help you find a plan that’s right for you.
Get the benefits of coordinated care, plus more choice and flexibility. HMO-POS plans typically let you see providers out of network for some services.
With PPO plans, you can visit any doctor, in or out of network, who accepts Medicare and ${company}'s plan terms. The freedom is yours.
Our dual-eligible Special Needs Plan is a type of Medicare Advantage plan, available to people living in our service area who have both Medicare and Medicaid. We can help you find out if you qualify.
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