Medicare Advantage
HMO Plans
Network-focused plans with referrals and prior auth that keep premiums and copays low. In-network MOOP protects against large bills.
The quick version
If you only read one thing, read this
- 1
Combines A, B (and often D) plus extras like dental/vision/OTC in one card.
- 2
Often $0 premium; copays/coinsurance until plan MOOP (typically $3,500–$7,550 in-network for 2026).
- 3
No health underwriting; enrollment limited to AEP (Oct 15–Dec 7), OEP (Jan 1–Mar 31), and qualifying SEPs.
The details
The stuff that matters, one piece at a time
Benefits
Combines A, B (and often D) plus extras like dental/vision/OTC in one card.
What it costs
Show me the money
- Plan Premium Range
- $0–$40 USDMost common $0 tier
- In-Network MOOP Range
- $3,500–$9,250 USDFederal max $9,250 for 2026
- Part B Premium Still Owed
- $202.90 USDMust pay Part B premium in addition to plan premium
- Typical In-Network MOOP
- $3,500–$7,550Plan-specific; federal max $9,250
- PCP Visit Copay
- $0–$20Varies by plan
The honest take
What's good, and where it falls short
The good stuff
- Often $0 plan premium
- Strong coordinated care through a PCP
- Typically lower MOOP than PPO
The catch
- Strict in-network requirement
- Specialist referrals needed
- No out-of-network coverage except emergencies
Head to head
HMO Plans vs. PPO Plans
HMO costs less but restricts provider choice. PPO offers flexibility at higher cost.
Buyer beware
The mistakes that cost folks the most
Not accounting for referral delays when you need specialist care quickly
Relying on an HMO while traveling a lot. There is no out-of-network coverage except emergencies
Not having a backup plan if your PCP leaves the network mid-year
Common questions
What folks ask us most
Keep learning
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The Insurance Hawk
Ready to put HMO Plans to work?
See the plans and the prices. Or talk it through with a licensed agent who works for you, not the insurance company.