Health Maintenance Organization (HMO) With a Health Maintenance Organization (HMO) plan, you choose a primary care physician (PCP) from Humana’s network to coordinate all of your care. An HMO plan is a good choice if you are willing to use certain providers in exchange for lower out-of-pocket costs.

How an HMO works

With an HMO, you’re responsible for copayments – fixed fees you pay when you see a doctor, have a prescription filled, or are admitted to the hospital.

• Select a primary care physician (PCP). You select a PCP who tends to the majority of your health needs and refers you to other in-network providers, if necessary. Each family member can choose his or her own PCP.
  
  
• Build a relationship with your PCP. You can seek guidance from your PCP when you need specialty care. Referrals to specialists may be required. A PCP is usually a general, family, or internal medicine doctor (internist), or a pediatrician.
  
  
• Take advantage of in-network savings. An HMO pays benefits only when you use doctors and hospitals in the plan’s network. For covered services at in-network providers, you pay a copayment and the plan pays the rest.
  
  
• Use out-of-network providers wisely. Coverage for services from out-of-network providers is only provided for emergencies or when Humana has given prior authorization.