Plans
HMO
Quick answer
A Medicare Advantage HMO is a plan that uses a specific network of doctors and hospitals. You choose a primary care provider (PCP) and usually need a referral to see specialists.
Plain-English definition
HMOs typically have the lowest premiums and the tightest networks. Out-of-network care is generally only covered in emergencies.
Why it matters
If your doctors are in-network and you like coordinated care, an HMO can offer strong value.
A simple example
Your HMO requires you to pick a PCP and get a referral before seeing a dermatologist.
Common mistakes & misconceptions
- Assuming any specialist will accept your HMO — always check the provider directory.
Related terms
PPO
A Medicare Advantage PPO lets you see providers in or out of the network, usually without a referral. Out-of-network care costs more and has its own MOOP.
Network
A network is the group of doctors, hospitals, and other providers that have contracted with a Medicare Advantage or Part D plan to deliver care and drugs at agreed rates.
Primary Care Doctor (PCP)
A primary care doctor (PCP) is the physician who coordinates your routine care. Most HMOs require you to select a PCP and get referrals through them.
Referral
A referral is your PCP's authorization to see a specialist. Most HMOs require one; most PPOs do not.
Medicare Advantage (Part C)
Medicare Advantage, also called Part C, is a way to receive your Medicare benefits through a private insurance plan approved by Medicare. Plans bundle Part A and Part B, usually include Part D drug coverage, and often add dental, vision, and hearing.
Frequently asked questions
Do HMOs need referrals?+
Usually yes for in-network specialists.
Sources & references
📚 Where this information comes from
- Medicare.gov — official U.S. government site for people with Medicare ↗Primary source for benefits, enrollment periods, and plan comparison.
- CMS.gov — Centers for Medicare & Medicaid Services ↗Federal rulemaking, program updates, and official guidance.
- Social Security Administration — Medicare enrollment & premiums ↗Enrollment, premium withholding, and IRMAA determinations.
When you're ready, compare plans on your own terms
See Medicare Advantage plans from the insurance companies we represent, or walk the course with a licensed agent whenever you'd like a second set of eyes.
We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.
Medicare Caddies is an independent insurance agency. We are not affiliated with, endorsed by, or connected to the U.S. government, the federal Medicare program, or the Centers for Medicare & Medicaid Services (CMS). We help compare Medicare Advantage plans from the insurance companies we represent, and we don't offer every plan available in your area.