HMO plans deliver the lowest premiums in exchange for staying inside a defined network. You choose a primary care physician (PCP) who coordinates your care and refers you to in-network specialists.
Typical cost
$280-$550/month for a single 40-year-old on a Silver HMO via Covered California (before subsidies).
How HMO plans work
- 01
Pick a PCP at enrollment.
- 02
PCP handles routine care and refers you to in-network specialists.
- 03
Out-of-network care is typically not covered (except emergencies).
- 04
Lower premiums, lower copays, lower deductible.
Pros
- • Lowest monthly premiums
- • Predictable copays
- • PCP coordination reduces fragmented care
Cons
- • Out-of-network care not covered
- • Referrals required for specialists
- • Network changes year-to-year
Best for
- Healthy families on a budget
- Anyone whose primary care is local
- Predictable-cost shoppers
Compare other plan structures
- PPO PlansMaximum flexibility - in-network preferred, out-of-network allowed.
- EPO PlansPPO flexibility for in-network care - no out-of-network coverage.
- Short-Term PlansBridge coverage for gaps - not ACA-compliant.
- Catastrophic PlansLow premium, high deductible - protects against worst-case medical events.