HMO plans
Network-focused plans with referrals and prior auth that keep premiums and copays low. In-network MOOP protects against large bills.
What it covers
- What it pays for
- Combines A, B (and often D) plus extras like dental/vision/OTC in one card.
- How it works
- In-network rules with PCP referrals required; must cover all Medicare-covered services.
- Who can get it, and when
- No health underwriting; enrollment limited to AEP (October 15 to December 7), OEP (January 1 to March 31), and qualifying SEPs.
What it costs
Often a low premium; copays and coinsurance until you reach the plan's in-network out-of-pocket maximum.
Hawkins Insurance Group, LLC is not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
What is good about it
- Strong coordinated care through a PCP
- Typically lower MOOP than PPO
The catch
- No out-of-network coverage except emergencies
HMO plans and PPO plans
| What is compared | HMO plans | PPO plans |
|---|---|---|
| Premium | Often lower | Often higher |
| Out-of-network coverage | Emergency only | Yes (higher cost) |
| Specialist referral | Required | Not required |
| Typical out-of-pocket maximum | Typically lower | Typically higher |
Mistakes to avoid
- Not accounting for referral delays when you need specialist care quickly
- Relying on an HMO while traveling a lot
- Not having a backup plan if your PCP leaves the network mid-year
Common questions
- If you travel extensively, a PPO or a Medicare Supplement may be better.