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An HMO – or Health Maintenance Organization – keeps costs low and predictable. With one doctor to coordinate your care, an HMO health plan is easy to use.
An HMO health plan offers:
An HMO health plan offers personalized care. Your care is coordinated by one doctor who knows you — your health history, current issues, medications, lifestyle and how your family health history may affect your health.
When you first sign up for an HMO health plan, you choose, or are assigned, a primary care physician (PCP).
Each person on your plan can pick a PCP. PCPs typically focus on general internal medicine or family medicine. Women and girls can choose an obstetrician/gynecologist (OB/GYN) as their PCP. Older adults can choose a geriatric doctor. Children can have a pediatrician.
If you're a member, you can find your PCP or your medical group listed on the front of your member ID card. You can also log in to Blue Access for MembersSM.
Your PCP is your partner in keeping you healthy. Here are some helpful tips for working with your PCP:
You can change your PCP at any time, except if you are hospitalized or in the 2nd or 3rd trimester of pregnancy.
Having one health care expert coordinate all your health care keeps your costs and health on track. An early diagnosis and treatment can prevent many common health issues from getting worse.
Year after year, BCBSTX HMO health plans help improve member health and lower their overall cost of care because health issues are managed before they get serious. People with chronic conditions such as asthma and diabetes often see the greatest results.
HMO health plans control costs through preventive health care that helps you avoid serious and costly health problems. Your costs are also lower because doctors and hospitals in the HMO network agree to offer their services at a set price.
The HMO network may include care and services from:
In most cases, your HMO health plan won't cover any of your expenses if you go to a provider who isn’t in your network. Here's why: Providers set their own prices for their services. These prices can vary by a few hundred to thousands of dollars for the same service. BCBSTX contracts with network providers who offer a service at a set price. Because out-of-network providers don't have a contract with us, we can't control how much they charge you. To avoid getting big bills, make sure you stay in your network.
How do I know if a provider is in my network?
To make sure a provider is in your plan's network, search Provider Finder®, our online directory. Provider Finder also has a cost estimator to help you figure costs for health visits, procedures, surgeries, diagnostics and imaging, vaccinations and other services.
If you're a BCBSTX member, register for or log in to Blue Access for Members, your secure account access site, for a personalized search based on your health plan and network.
Helpful hint: No matter which type of plan you have, get to know it, what's covered and where you can go for care before you need it. Knowing how your plan works may save you time and money. Learn more about how HMO insurance works.
Originally published 5/23/2022; Revised 2022
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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