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What Is an HMO?
HMO: Roadmap to Savings
Follow the road signs for quick tips to get the most out of your HMO network.
If you're looking for a health plan that's easy to understand, easy to use and easy on your wallet, an HMO may be just what you need for you and your family.
HMO. It's Care. Simplified.
An HMO, or Health Maintenance Organization, is designed to keep costs low and predictable. With one doctor to coordinate your care, an HMO health plan is easy to use and may be just what you’re looking for.
An HMO health plan offers:
- Monthly premiums, copays and deductibles are often lower than other types of plans.
- Access to certain doctors and hospitals, called your HMO provider network, which helps control how much you pay for health care.
- A primary care physician (PCP) who you see for routine check-ups, physicals, colds and flu. Your PCP will refer you to a specialist for more serious illnesses.
HMO. It's Personal.
An HMO health plan is care personalized to meet your needs. Your primary care doctor, or PCP, gets to know you, your health history and your family’s health history and how it may affect your health. Think of them as your personal care doctor. Helpful hints for finding a new doctor.
When you first sign up for an HMO health plan, you choose, or are assigned, a primary care physician (PCP). Each family member on your plan can have their own PCP. PCPs can be doctors who practice:
- Family medicine
Your PCP is listed on the front of your Blue Cross and Blue Shield of Texas (BCBSTX) member ID card or you can find it when you log in to your Blue Access for MembersSM account.
How do I Change my PCP?
You can change your PCP at any time, except if you are hospitalized or in the 2nd or 3rd trimester of pregnancy.
- Log in to Blue Access for Members
- Choose the Change PCP link
- Follow the instructions
- Call the Customer Service number on the back of your BCBSTX member ID card.
HMO. It's Coordinated.
HMO health plans are designed to help you stay healthy. Having one health care expert — your PCP — to coordinate all your health care needs keeps your costs and your health on track. An early diagnosis and treatment can keep many common health issues from getting worse.
Year after year, BCBSTX HMO health plans have proven to help improve member health results and lowered their overall cost of care because health issues are managed before they get serious. People with chronic conditions such as asthma and diabetes have seen the greatest results.
Working with Your PCP
Think of your PCP as your personal care doctor. Follow these guidelines to make the most of your relationship:
Download the You and Your Doctor guide
- Make Your First Appointment. If you're a new patient, see your PCP right away to help avoid delays later when you are sick or need a referral. Let the doctor's office know that you're a new patient.
- Get a Referral.If you need to see a specialist, test or procedure, your PCP will refer you to a provider. Make sure the provider is in your network. You don't need referrals for mammograms, OB/GYN and behavior health services, as long as they are in the HMO network.
In addition, you will need a referral to visit a hospital for non-emergency services. You can search for participating hospitals and providers in Provider Finder to see who is covered in your network.
- For Non-Emergencies. See your PCP first for minor illnesses like a cold, flu, minor cuts or burns. If the office is closed, call the doctor's after-hours number. They will either try to fit you in or refer you to another doctor or clinic. In some cases, they may have you go to the hospital.
- For Emergencies. For life-threatening illnesses or injuries, call 911 or go to the nearest emergency room. You don't have to go in-network or get a referral. But do tell your PCP about your emergency as soon as you can so they can follow your treatment and manage any follow-up care.
HMO. It's Affordable.
HMO health plans are designed to control costs through preventive health care that helps you avoid serious and costly health problems. Your costs are also kept low because the doctors and hospitals in the HMO provider network agree to offer their services at a set price.
The HMO network may include care and services from:
- Imaging centers
- Medical equipment vendors
To avoid getting big bills, make sure you stay in the HMO provider network. If you go outside of the HMO network, in most cases, your HMO health plan won't cover any of your expenses. This is because providers set their own prices for their services which can vary by a few hundred to thousands of dollars. Because out-of-network providers don't have a contract with us, we can't control how much they charge you.
Find in-network providers in Provider Finder®
To make sure a provider is in the HMO network, search Provider Finder, our online directory. If you’re a BCBSTX member, log in to Blue Access for Members for personalized results based on your health plan and network. Provider Finder also has a cost estimator to help you find costs for health visits, procedures, surgeries, diagnostics and imaging, vaccinations/immunizations and other services.
Helpful hint: No matter which plan you have, before you need care, get to know your plan, what's covered and where you can go for care. Knowing how your plan works may save you time and money. Learn more »