HMO Plans

Health Maintenance Organization (HMO) plans are another type of Medicare Advantage (Part C) plan. If you’re interested in learning more about the coverage you can get with an HMO plan, we have outlined everything you need to know below.

What is an HMO Plan?

The Medicare Advantage HMO plan has a network of health care providers, doctors, and hospitals. You will generally need to get your care and services from this provider network, unless it is an emergency, or if:


  • You need out-of-area dialysis
  • You need out-of-area urgent care


HMOs will also provide the same coverage as Original Medicare (Parts A and B), and may also include additional coverage, such as:

Do HMOs Cover Prescription Drugs?

Most HMO plans will provide coverage for prescriptions drugs, but asking the plan first will help you determine if the plan actually does or not. If you want prescription drug coverage, you must join an HMO plan that provides drug coverage.

What Else Do You Need to Know About HMO Plans?

With HMO plans, you will typically need to choose a primary care doctor and get a referral to see a specialist that is within your plan’s network. If you choose to receive your care and services outside of the plan’s network, you will likely pay the full cost of the service out-of-pocket.


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If you’re interested in learning more about your Medicare Advantage options, including HMO plans, give American Family Solutions a call today. We will help you compare your options to find the coverage you need.