What Is An HMO?

Blue Cross and Blue Shield of Illinois HMO

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.

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. Your PCP will refer you to a specialist for more serious illnesses.

HMO. It's Personal.

An HMO health plan is designed so that you have care personalized to you. 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.

If you're a member, you can find your PCP or your medical group listed on the front of your Blue Cross and Blue Shield of Illinois member ID card or by logging in to Blue Access for MembersSM.

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. If you're a BCBSIL member, register or log in to BAMSM, 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 or medical group/IPA at any time unless you are hospitalized or in the 2nd or 3rd trimester of pregnancy.

  • To change doctors within the same medical group: Search our Find Care tool to find doctors in your medical group. Then, call the medical group (MG/IPA) on your BCBSIL ID card and ask to change doctors.
  • To change to a different medical group: call the Customer Service number on your BCBSIL member ID card.

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:

  • 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.

Last Updated: Nov. 30, 2023