What is an HMO?

It's Care. Simplified.

An HMO 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 provider (PCP) who you see for routine check-ups, physicals, colds and flu. Some HMO plans require your PCP refers you to specialists and some HMO plans let you see specialists in your network without a PCP referral. Check your benefit details before you make an appointment with a specialist.

It's Personal.

An HMO health plan is designed so that you have care personalized to you. Most of the time, your care is coordinated by one doctor who knows you — your health history, current issues and medication, lifestyle and how your family's health history may affect your health.

Getting Started

When you first sign up for an HMO health plan, you choose, or are assigned, a PCP. Each person on your plan can pick their own PCP. PCPs typically focus on general internal medicine or family medicine. Women and girls can choose an OB/GYN or a Woman's Principal Health Care Provider (WPHCP) as their PCP. Older adults can choose a geriatric doctor. Children can have a pediatrician as their PCP.

How do I know if a provider is in my network?

To make sure a provider is in your plan's network, search our Find Care tool. Register or log in to Blue Access for Members^SM, your secure member website, for a personalized search based on your health plan and network.

• If you're a new patient, see your PCP right away. When you make your first appointment, let the doctor's office know that you're a new patient.
• Get a referral. If you need to visit a specialist, behavioral health care provider or hospital for non-emergency services, your PCP will refer you to one. Make sure the specialist or behavioral health care provider is in your network. Women don't need a referral to see your in-network WPHCP.
• Call when you need care. Your PCP should be your first stop when you need care. Please call their office or after-hours phone number for any health care needs. In emergency cases, they may have you go to the hospital.
• For real emergencies. If your illness or injury is life-threatening, call 911 or go to the nearest emergency room. You don't have to stay in-network or get a referral. Just let your PCP know that you had an emergency as soon as you can so they can follow your treatment and manage any follow up care needed.

Can I Change my PCP?

Of course! You can change your PCP at any time unless you are hospitalized or in the 2nd or 3rd trimester of pregnancy. To change to a different PCP, search our Find Care tool to find doctors in your network. Then, call the Customer Service number on your BCBSMT member ID card.

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:

• Doctors
• Hospitals
  
• Clinics
• Pharmacies
• Labs
• Imaging centers
• Medical equipment vendors

In most cases, your HMO health plan won't cover any of your expenses if you go to a provider who is not in your network.