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If you want Medicare Prescription Drug Coverage (Part D), you must join an HMO that offers prescription drug coverage."/> <meta name="Generator" content="Drupal 9 (https://www.drupal.org)"/> <meta name="MobileOptimized" content="width"/> <meta name="HandheldFriendly" content="true"/> <meta name="viewport" content="width=device-width, initial-scale=1.0"/> <link rel="icon" href="/web/20221003153201im_/https://www.medicare.gov/sites/default/files/favicon-mgov.ico" type="image/vnd.microsoft.icon"/> <link rel="alternate" hreflang="en" href="https://web.archive.org/web/20221003153201/https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health-plans/medicare-advantage-plans/health-maintenance-organization-hmo"/> <title>Health Maintenance Organization (HMO) | Medicare</title> <link rel="stylesheet" media="all" href="/web/20221003153201cs_/https://www.medicare.gov/sites/default/files/css/css_YEhoFWmWOOaZ5ajuCpN9vUpcjUcp1EWrY8F4MRlFOw8.css"/> <link rel="stylesheet" media="all" 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m-evo--navigation__item--last"> <a href="/web/20221003153201/https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances-special-enrollment-periods" class="ds-c-vertical-nav__label m-evo-vertical-nav__label m-evo--navigation__link--level-1" data-drupal-link-system-path="node/27281">Special circumstances (Special Enrollment Periods)</a> </li> </ul> </nav> </div> </div> <main id="content" class="ds-l-col--12 ds-l-md-col--8 primary-content__content with-secondary-nav"> <div class="region region-content"> <div id="block-medicare-evo-page-title" data-block-plugin-id="page_title_block" class="block block-core block-page-title-block"> <h1 class="m-evo--page-title "><span>Health Maintenance Organization (HMO)</span> </h1> </div> <div id="block-medicare-evo-landingpageblock" data-block-plugin-id="landing_page" class="block block-landing-page"> <div class="landing_page"></div> </div> <div id="block-medicare-evo-content" data-block-plugin-id="system_main_block" class="block block-system block-system-main-block"> <article role="article" about="/sign-upchange-plans/types-of-medicare-health-plans/medicare-advantage-plans/health-maintenance-organization-hmo" class="node node--type-page node--view-mode-full"> <div class="node__content"> <div class="m-evo--main-content"><p>In HMO Plans, you generally must get your care and services from doctors, other health care providers, and hospitals in the plan's network, except:</p> <ul><li>Emergency care</li> <li>Out-of-area urgent care</li> <li>Temporary out-of-area dialysis</li> </ul><p>HMO Point-of-Service (HMOPOS) plans are HMO plans that <strong>may allow you to get some services out-of-network for a higher copayment or coinsurance</strong>. It鈥檚 important that you follow the plan鈥檚 rules, like getting prior approval for a certain service when the plan requires it. 聽<a data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="aeeeae9c-c5de-454e-ac81-17978ed3ce09" href="https://web.archive.org/web/20221003153201/https://www.medicare.gov/plan-compare/#/" title="Find health & drug plans">Find and compare HMO Plans in your area</a>.</p> <h2>Are prescription drugs covered in Health Maintenance Organization (HMO) Plans?</h2> <p>In most cases, prescription drugs are covered in HMO Plans. Ask the plan. If you want <a data-content="<div class="rxbodyfield"><p>Optional benefits for prescription drugs available to all people with Medicare for an additional charge. This coverage is offered by insurance companies and other private companies approved by Medicare.</p></div>" class="ds-c-tooltip__trigger-link"> Medicare drug coverage (Part D) </a>, you must join an HMO Plan that offers prescription drug coverage.聽If you join an HMO plan without drug coverage, you can鈥檛 join a separate Medicare drug plan.</p> <h2>Do I need to choose a primary care doctor in Health Maintenance Organization (HMO) Plans?</h2> <p>In most cases, yes, you need to choose a primary care doctor in HMO Plans.</p> <h2>Do I have to get a referral to see a specialist in Health Maintenance Organization (HMO) Plans?</h2> <p>In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don't require a referral.</p> <h2>What else do I need to know about this type of plan?</h2> <ul><li>If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another doctor in the plan.</li> <li>If you get health care outside the plan's <span data-embed-button="hover_lower" data-entity-embed-display="view_mode:node.hover_lower" data-entity-type="node" data-entity-uuid="265af74a-a86d-48e8-89c9-5735afb1529a" data-langcode="en" class="embedded-entity"> <span data-display="hover-lower" data-content="<p>The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.</p> " role="article" about="/node/34361" class="m-evo-brief--hover"><span class="m-evo-brief--content">network</span></span></span> , you may have to pay the full cost.</li> <li>It's important that you follow the plan's rules, like getting prior approval for a certain service when needed.</li> </ul></div> </div> </article> </div> </div> </main> <div id="lower-content" class="ds-l-col--12 ds-l-md-col--8 ds-u-margin-left--auto primary-content__lower-content"> <div class="m-evo--link-list 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