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HMO stands for Health Maintenance Organization. It’s a type of health plan that gives you access to a network of doctors and hospitals, often called “providers.” This group of health care professionals work together to provide you with a full range of covered health care services. HMO is different from PPO (Preferred Provider Organization) insurance in a few ways.
If you need to see a specialist or need any special tests, you will need a referral from your PCP before seeing another doctor. Search our Provider Finder to make sure the specialist is in your network. Remember, if the specialist isn’t in your network, or if you haven’t received a referral from your PCP, the services won’t be covered.
Whenever you have questions about your HMO plan, use our handy resources. Sign up for Blue Access for MembersSM (BAM) or call the customer service number on the back of your member ID card. It lets you keep track of your balances, claims status, benefits, coverage details and more.
If you’re not a member yet, but are considering buying an HMO Insurance plan, check out our shopping guide.
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Originally published 10/2/2018; Revised 2021
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