What are disadvantages of HMO?

Question

Rodney Powell · Accepted Answer

•  Limited provider networks

•  Most require referrals from your primary care doctor

•  Out-of-pocket costs like deductibles, copays, and coinsurance

•  The big one — prior authorizations are often required for many services

Mike Alexander · Answer

1 restricted list of providers
2 must get a refferal to see a specialist
3 travel outside of your right home area
4 dealing  with managed care is s ues
5 not having ability to see specialists younwant if not in network

Daniel Brechin · Answer

HMO programs began with contracted Doctors that are contracted with the HMO plan.   A member will chose a primary Doctor and use that Doctor to guide him through the members health care.

William Lawler · Answer

The biggest disadvantage when it comes to an HMO, which is a health maintenance organization, is that you have to go to their network doctors and dentists. If you go out of network, it may cost you more money. The other disadvantage to an HMO is that if you want to see a specialist, you have to have a referral from your primary care physician. That's it.

Mark Maliwauki · Answer

Closed network, no real value outside of your county let alone your state. However, HMO's are cheaper to operate than PPO's so they will soon dominate the market.

Charise Karjala · Answer

What are the disadvantages of HMO Medicare? Well, by speaking of HMO Medicare generally, we're referring to most of the Medicare Advantage policies that are available in the country. These are managed care, which means that we're within a limited network of providers and that we need to follow the rules, the procedures, and regulations to stay in network with that provider network.

So, what are the disadvantages? I'd like to answer this in the other way around. What are the advantages? The first advantage is that you're not self-administering your medical care. You can rely upon a system to administer your benefits according to the CMS regulations, and there's a lot of clout behind that. If it doesn't go your way, you've got grievances, appeals, and you can go to the Department of Managed Care to complain to, which has very large sticks. Your protections are great using managed care.

Now, the disadvantages are that you can't pick your doctor. You may not be able to go to a private hospital electively. There's a number of other issues, especially if you're trying to get diagnostics and you've got a limited diagnostician within your network. Then you're going to be somewhat limited.

However, here's my strategy, and I just worked with one of my clients on this. He's spending $5,000 a year on premium only. He needs to see two doctors. It doesn't make much sense financially. So we did the math, and he is going to go into a managed care HMO so that he has 100% protection, no matter what happens in an emergency. He has $5,000 left over to go and see whichever doctors he chooses, whether that's a chiropractor or, in his case, a mental health provider, and he can choose to spend that five grand however he wants.

And he still has all of the protections of good Medicare. So there you go. That's something to think about. So not just disadvantages. It all depends on how you want to skin that cat, so to speak.

Edward Smith, ChFC, CRPS, AIF · Answer

Mostly the limitations of only having coverage for in network services, except for emergencies and some offer limited situations.

Ray McCauley · Answer

limitted doctor choice to the plans list.  Higher out of pocket costs than medicare supplement plan options.

Justin Doherty · Answer

Typically, the only disadvantage I see with an HMO is the network restrictions. There is NO out-of-network coverage with an HMO, so you have to be very careful to only use providers that accept your plan. Additionally, you might have to worry about seeing your PCP to get referrals to specialists before you can schedule those visits.

Answered by Justin Doherty on September 26, 2025

Broker Licensed in PA, CO, CT & 11 other states

Answered by Justin Doherty Medicare Insurance Agent

Don Hudson · Answer

One major disadvantage is that it is difficult to get any specialized care because the members must get a referral first. Another disadvantage is you are almost always required to only use providers in your network if you want the HMO plan to cover the expenses.

Answered by Don Hudson on September 22, 2025

Broker Licensed in FL

Answered by Don Hudson Medicare Insurance Agent

Michael Andrews · Answer

The question is, what are the disadvantages of an HMO? So, the disadvantage of an HMO versus, say, a PPO is that with an HMO, you do not have the option to go out of network. Depending on the plan, you may be able to go out of network in an emergency situation. But if you wanted a second opinion and your doctor does not take the HMO, you would not be able to see that doctor and have insurance pay anything towards it.

If you have a PPO, the doctor still has the ability to refuse to charge your insurance, even though you have a PPO. However, if he or she agrees, it will most likely be at a higher cost share.

So, for an example, say if you have an HMO plan and your copay is $50. However, if you're out of network, the copay instead of being $50 could be something called a co-insurance. And let's say that could be 20% or more, depending on the situation. Hopefully, this helps for you.

Patricia &#039;Tif&quot; Bush · Answer

Some of the disadvantages of an hmo are that you have to stay in network except for emergency or walk-in coverage. You have a out-of-pocket maximum that can be pretty high.

Daniel Maisel · Answer

Though Medicare Advantage plans 
(Plan C) can have good benefits, and HMO limits your Healthcare to your contracted network.

Their are other Medicare options that have less restrictions like PPO's and /or Medicare Supplements (Medi-Gap).

Many like a Medi-Gap plan because you can go to almost any Doctor in the USA.

Would you prefer that freedom?

When you are younger & healthier the freedom may not seem important. As we grow older, the odds are that we may have greater health issues where would prefer a greater selection of the highest caliber of available doctors. Some may not accept HMO'S or even PPO's.

Daniel Maisel Insurance - Medicare Agency

Mitch Anderson · Answer

A disadvantage of HMO would generally be the network access. HMO plans have a narrow network, sometimes including only 1 healthcare system. Make sure you understand the network limitations of the HMO prior to completing an application, education is the key! The network limitations are not necessarily a negative as the premium is usually lower compared to other similarly benefited PPO plans.

Answered by Mitch Anderson on September 2, 2025

Agent Licensed in MN, IA & WI

Answered by Mitch Anderson Medicare Insurance Agent

Roger Werking · Answer

HMO's do not have as many doctors to choose from as a PPO would.

You have to have referrals to see aspecialist. With a PPO you do not need referrals.

Charles Calvin · Answer

The only disadvantage of an HMO is if you want to see a provider that is not in the network. Otherwise, an HMO is perfectly fine, and costs are cheaper than on a PPO. If you have doctors that are out of network, or if you travel frequently, then an HMO may not be a best fit. Which type of plan is most suitable for your needs can be determined by a licensed broker, as we can compare and contrast across multiple carriers to find that best fit.

Answered by Charles Calvin on February 27, 2026

Broker Licensed in MO, FL, IA, IL, KY & SC

Answered by Charles Calvin Medicare Insurance Agent

Mike Cooper · Answer

Please allow me to first explain the difference between an HMO and a PPO.  An HMO gives you benefits in-network ONLY.  If you choose to go out-of-network, there's no benefits there... so you'll pay full price.  

A PPO gives you in-network benefits... and, it will allow you to go out-of-network.  There's just typically a higher cost for the out-of-network options.

Generally speaking, the benefits in an HMO tend to be better.  Why?  Consider this... the insurance company controls ALL of the costs in an HMO.  The doctors and hospitals have already contractually agreed to the carrier's/insurance company's reduced pricing/negotiated rate.

In a PPO, the insurance company does NOT control the out-of-network pricing, so they will (again, generally speaking) protect themselves by reducing the benefits available in their PPO policies vs the HMO.

The downside of an HMO?  You might be required to get a referral in order to see a specialist.  Sounds like a pain in the butt...  and often it is.  Why is this often a requirement??  Welp...  if you self-diagnose yourself with brain tumor (God-Forbid) and your diagnosis is inaccurate, that high-paid neurologist is going to be a little upset if you were wrong.  They don't make money of the office visits, they make $$ on surgeries.  For this reason, they prefer a medical doctor check you first.

In Summary:
Talk to a qualified agent.  A good agent can help guide you through the benefits that make the most sense based on your needs and your budget.  If they can find a strong network of doctors and hospitals... and you're somewhat flexible with your chosen doctors, we can help simplify your decision making process!

Blessings-
Mike Cooper

Stuart Graham · Answer

This question is hard to answer because it is very dependent on the HMO we are talking about. The obvious disadvantage would be that no out-of-network care is covered by the plan. But we have seen recently that providers refuse to take a PPO out-of-network, meaning the member didn't fare any better with the PPO.

Some HMO plans that have large networks are more stable and have better benefits than PPOs. Again, this is dependent on the plan and the area of the country.

Another potential disadvantage could be having to get referrals to see specialists; however, many HMO plans have removed that requirement, and you can see any in-network physician without a referral. Those plans function very similarly to a PPO.

I hope this helps, but I hope you can see it's not a black-and-white answer!

Steven Bleicher · Answer

If you are new to Medicare and understand that an HMO is a Network-based Advantage plan, you might want to reconsider another type of Advantage plan which is known as a PPO (or Preferred Provider Organization). This allows you to go both IN-Network as well as OUT of Network doctors. So, if your your "favorite" doctor is with Company X, that would be the insurance company to interview with an longtime experienced agent. However, it is going to be more likely that you enjoy dealing with a few different doctors. 

So, here's where the complication arises. This has happened to me on many occasions: My prospect gives me 5 names of doctors with certain specialties. Usually two of them are in one network while the remaining three are a part of a different network. Now it is up to you to determine whether it is best to choose the 2 doctors' network vs. the 3 doctors' network? Normally, a patient wants to retain their Primary Care physician and their cardiologist, as an example. So, it becomes necessary for your agent (be sure she/he is experienced enough to guide you in this important comparison)! It is extremely rare in my example for all 5 doctors being in the same network. 

The other dilemma with HMO/PPO's are that "Prior Authorization" is a part of both these plans. This is when a doctor has scheduled a test or treatment for you but has failed to receive your Advantage plan's company's approval. This is becoming more and more commonplace these days. Thus, it is imperative for your doctor to get this "advanced approval" or your procedure will be delayed by weeks! The same holds true for a doctor's prescription for an expensive RX. This could require what is called "step therapy" where the insurance company wants you to use a less expensive drug for your treatment. In not having gotten prior authorization, you are deprived of the "better" drug until the "other" cheaper drug has been eliminated.

Andrew Zurbuch, MBA · Answer

They are more restrictive than a Preferred Provider Organization, PPO, plan. They attempt to control costs, & can have narrow networks, which can mean a small network comparatively. Thank you.

Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Diana Garner · Answer

A disadvantage of HMO plans is that you are restricted to a limited network of providers.  You must see a provider who is in network with the plan. The only time you have out-of-network coverage is in the event of an emergency.

Another disadvantage is that you may need a referral from a primary care doctor to see specialists.

Don Golding · Answer

In the Medicare space, HMOs have advantages and disadvantages. HMOs require you to stay in network to receive any benefit, usually require a referral from your PCP to see a specialist, and may have prior authorization requirements. However, HMOs often offer the richest benefits, lowest copays, and maximum out-of-pocket protection. Generally, they also provide desired ancillary benefits, such as dental, vision, hearing, and over-the-counter medications, among others. As with all Medicare plans, it is vital to know the benfits and understand how the plan works. Everyone is different; one type of plan does not work for all. Find an agent who represents a broad variety of plans to help you find the plan to fit your needs.

Answered by Don Golding on September 9, 2025

Broker Licensed in TX, AL, AR & 5 other states

Answered by Don Golding Medicare Insurance Agent

Richard Kozlowski · Answer

No disadvantages - read the studies from companies like Kaiser Permanente
as to the advantages.

Cheryl Lockhart · Answer

While there are advantages to an HMO like extra services of dental, vision and hearing, often some over-the-counter products are covered, they can also have certain limitations. Generally, you are required to stay within the plan's provider network, get referrals to see specialists, and could have less flexibility in choosing providers. There are out of area limits and prior authorization for procedures, tests or medications.

Answered by Cheryl Lockhart on October 31, 2025

Agent Licensed in FL, CO, KY, NC & WV

Answered by Cheryl Lockhart Medicare Insurance Agent

Heidi Wotton · Answer

HMOs can save money, but they’re best for people who are comfortable staying in one network and getting referrals. If flexibility and provider choice matter more, another plan type may be a better fit.

Answered by Heidi Wotton on February 3, 2026

Agent Licensed in ME, FL, LA & 7 other states

Answered by Heidi Wotton Medicare Insurance Agent

Robert Helmkamp II · Answer

The disadvantage of a HMO plan is that you must use doctors that are in network with that certain plan in order to have the services covered. Any medical services received from an out of network provider will not be covered and patient will pay entire cost. PPOs allow you to see doctors outside the plans network, usually for a set higher copay, but PPO plans will usually have higher copays for most all services compared to HMO plans.

Answered by Robert Helmkamp II on November 3, 2025

Broker Licensed in AZ

Answered by Robert Helmkamp II Medicare Insurance Agent

Kathy Olejniczak · Answer

The only real negatives of and HMO is that You can only use in network providers and in most cases you need referrals to specialists.

Ami Fouts · Answer

HMO’s have a set network of doctors, so if you wanted to see a doctor outside of their network, they will not pay for that service.

Fred Manas · Answer

HMOs (Health Maintenance Organizations) have some significant drawbacks, primarily related to limited provider choices and the need for referrals. Specifically, HMOs restrict members to in-network providers, meaning you'll need a referral from your primary care physician (PCP) to see a specialist, and out-of-network care is generally not covered except in emergencies. 
Detailed Disadvantages:
Restricted Provider Network:
HMOs require you to use doctors and hospitals within their network. This can be limiting if your preferred doctors are not in the network, or if you travel frequently and need care outside your network's coverage area. 
Referral Requirement:
To see a specialist, you typically need a referral from your PCP, which can add extra steps and potentially delay care. This can be frustrating for those who prefer direct access to specialists. 
Limited Out-of-Network Coverage:
Out-of-network care is generally not covered by HMOs, except in emergencies, and even then, the definition of "emergency" can be strict. This means you'll be responsible for the full cost of any non-emergency care received outside the network. 
Potential for Disrupted Care:
If your PCP leaves the HMO network, you'll need to find a new one, potentially disrupting your established care relationships. This can also happen if your specialist leaves the network. 
Increased Cost for Out-of-Network Care:
While HMOs often have lower premiums than other types of plans, the costs associated with out-of-network care can be significantly higher, negating any initial premium savings.

Vachik Chakhbazian · Answer

have some significant drawbacks, primarily related to limited provider choices and the need for referrals. Specifically, HMOs restrict members to in-network providers, meaning you'll need a referral from your primary care physician (PCP) to see a specialist, and out-of-network care is generally not covered except in emergencies.

Answered by Vachik Chakhbazian on June 30, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Andrew Kramer · Answer

Some people consider the following to be disadvantages of an HMO Medicare Advantage plan, however, I do not. #1 need referrals to see most specialists. #2 Can only see Dr's in the HMO network. #3 Cannot see Dr's outside of the county or counties of the HMO plan. However, the Advantages are: #1 low co-pays. #2 during travel in the US, can get care at any urgent care, or the ER of any hospital, on the co-pays of your plan. #3 typically better ancillary benefits, i.e. dental, vision and OTC. #4 better health outcomes because your PCP is monitoring all your specialist visits and Rx's. I believe the advantages of an HMO outweigh the disadvantages, especially better health.

Answered by Andrew Kramer on July 22, 2025

Agent Licensed in FL

Answered by Andrew Kramer Medicare Insurance Agent

Carol Thompson · Answer

The most common disadvantages of a HMO is having to get referrals from your primary care Dr. to see specialists or to have other testing and exams completed outside of the primary care scope. Often the delay is awaiting authorizations by the insurance carrier.

Answered by Carol Thompson on December 3, 2025

Broker Licensed in FL, LA, MI & NC, SC, VA & WI

Answered by Carol Thompson Medicare Insurance Agent

Mike Henry · Answer

Many disadvantages. Your dr or hospital may not be in it. HMO’s can quickly myay not be available. Company may pullout or Dr may quit them. Usually because of money issues. Also full of copayments and deductibles

Answered by Mike Henry on July 31, 2025

Agent Licensed in TX

Answered by Mike Henry Medicare Insurance Agent

Jack Mayer · Answer

In my experience I have found that it just depends on where you are, where you live. Some rural areas in various states have a very small foot print and if you live in one of those areas where the network is small then you may not be too happy with a Medicare Advantage Plan which are typically HMO's because there may not be too many providers or medical groups to choose from.

Answered by Jack Mayer on December 29, 2025

Agent Licensed in CA & NV

Answered by Jack Mayer Medicare Insurance Agent

Jennifer Kalbach · Answer

What I would consider to be a big disadvantage to an HMO is the limitations to a network of doctors under a Health Maintenance Organization. This is not a good plan for someone who may be seasonal in one location or travels outside of their immediate network as there is no coverage outside of your network of providers and can become costly.

Answered by Jennifer Kalbach on November 24, 2025

Agent Licensed in KY

Answered by Jennifer Kalbach Medicare Insurance Agent

Joseph Peck · Answer

If you need care and where you are at they do not take your HMO you could be responsible for the whole bill. Also the Primary doctor has to refer to wherever you go, or again, you could be responsible for the whole bill.

Answered by Joseph Peck on March 30, 2026

Agent Licensed in MI, AL, CO, KS & TN

Answered by Joseph Peck Medicare Insurance Agent

Ken Banks · Answer

The primary disadvantages of an HMO (Health Maintenance Organization) health insurance plan are its limited provider network, the need for referrals to see specialists, and no coverage for out-of-network care except in emergencies.

Answered by Ken Banks on November 17, 2025

Broker Licensed in GA, AL, DC & 5 other states

Answered by Ken Banks Medicare Insurance Agent

Lillian Hill · Answer

Often, when I think about Health Maintenance Organization Plans (HMOs) from a personal standpoint, the out‑of‑pocket costs, network rules, and limits on seeing specialists or certain hospitals can feel like disadvantages — but that really depends on who you ask. Many people actually view the structure of having all their medical services bundled into one coordinated package as an advantage.

🦉

Adam Paul · Answer

All services have to be rendered in network unless it’s an emergency and you have to have an appointment with your primary care physician to give you the referral to see a specialist that is part of the same network.

Answered by Adam Paul on October 27, 2025

Broker Licensed in CA, NV, OK & OR

Answered by Adam Paul Medicare Insurance Agent

Patricia Graham · Answer

Freedom of choice, and in network physicians and hospitals. I find that for some clients, it is perfectly fine, as for others with more complex medical issues, they prefer to have a more robust plan to fit their needs.

Answered by Patricia Graham on August 10, 2025

Agent Licensed in WA

Answered by Patricia Graham Medicare Insurance Agent

Julia Alves · Answer

An HMO (Health Maintenance Organization) can be a good fit for some people, but there are a few downsides to be aware of:

Limited provider network – You generally must use doctors and hospitals in the plan’s network, except in emergencies.

Referrals are usually required – You might need to see your primary care doctor first to get a referral for specialists.

Less flexibility – If you like choosing your own specialists or seeing providers outside the network, an HMO can feel restrictive.

Out-of-network care is typically not covered – Non-emergency care outside the network is usually paid fully out of pocket.

HMOs often have lower premiums and predictable costs, but the trade-off is less freedom when choosing providers.

Samantha Jones · Answer

You have to stay within the network of the hmo plan and you will always need a referral to see any specialists

Kevin Johnson · Answer

Health Maintenance Organizations (HMOs) have several disadvantages, including: 
Limited Choice of Providers: HMOs restrict patients to a network of pre-selected healthcare providers. This may limit access to preferred or specialized doctors outside the network. 
Referral Requirements: Patients typically need to obtain referrals from their primary care physician (PCP) to see specialists or receive certain medical services. This can delay treatment and create administrative hurdles.

Holt Rushing · Answer

Not being able to go to doctors outside of the network. Also, not being able to go to more dentists and optometrists.

Maurice Ellis · Answer

Here are some common disadvantages of HMO (Health Maintenance Organization) plans:
	1.	Limited Provider Network
	•	You must use doctors, specialists, and hospitals within the plan’s network.
	•	Out-of-network care usually isn’t covered (except for emergencies).
	2.	Primary Care Physician (PCP) Requirement
	•	You’re required to choose a PCP.
	•	All specialist visits usually need a referral from your PCP, which can slow down care.
	3.	Less Flexibility
	•	Unlike PPOs, you don’t have freedom to see providers outside the network without paying the full cost.
	•	This can be a problem if you travel often or need a specific specialist not in the network.
	4.	Geographic Restrictions
	•	HMOs typically serve a local/regional area.
	•	Care outside that service area may not be covered unless it’s an emergency.
	5.	Limited Specialist Access
	•	You may face longer wait times for referrals or see fewer specialists compared to other plan types.
	6.	Potential for Higher Out-of-Pocket Costs If Out-of-Network
	•	If you mistakenly go outside the network, you’re usually responsible for the entire bill.
	7.	Less Patient Autonomy
	•	The referral system and care coordination through your PCP may feel restrictive to people who prefer more control over their care choices.

Sue Mendoza · Answer

A minor disadvantage of a HMO is that you will need a referral from your primary care doctor in order to see a specialist. At the beginning of the year, your primary care doctor can send referrals to your specialists and the referrals are good for one year!

Nicolas Cain · Answer

Disadvantages of an HMO include limited provider network, required referrals for specialists, less flexibility, no out-of-network coverage (except emergencies), and limited travel coverage.

Michael Cavanaugh · Answer

Basically, you need to select a Primary Care Provider and he/she directs all of your care. You also need to stay within a certain service area and cannot go out of the network. Certain services must have prior approval.

Answered by Michael Cavanaugh on December 1, 2025

Broker Licensed in PA, DE, FL, MD & NJ

Answered by Michael Cavanaugh Medicare Insurance Agent

Aaron Lewis · Answer

HMO Medicare Advantage Plans disadvantage is that you must stay within the network of providers that take that plan. In the event of an emergency situation you can go to any provider in or out of network.

Answered by Aaron Lewis on June 30, 2025

Agent Licensed in NJ

Answered by Aaron Lewis Medicare Insurance Agent

Nkechi Nwankwonta · Answer

Some disadvantages are a limited network, you do not have the option to go to any doctor you like and doctor can decide to no longer take an insurance plan at anytime so the network does change often. Another one, in my opinion, is people not understanding the actual cost of that plan. They see the $0 amount and $0 for primary care but some time don't understand that even if you do have to pay to see you PCP you still have to pay for services that that doctor may do.

Answered by Nkechi Nwankwonta on November 1, 2025

Agent Licensed in TX, AZ, CA & 18 other states

Answered by Nkechi Nwankwonta Medicare Insurance Agent

Christopher DiBiase · Answer

Medicare Advantage Plans have 2 main networks: HMO and PPO. HMO is a smaller, trusted network for which the carrier has set pricing for the services and benefits. Depending on the carrier and the location, these can be restrictive. They will have all types of specialists, hospitals, dentists, urgent care etc. It may not be your favorite or the one next to your location. Your primary care provider will refer you to other in-network providers to keep your costs lower. In some cases, you can ask for another provider, but they will have to be within the network. 
   With a PPO, you can choose to go to out-of-network providers but there is usually a higher cost with the premium and/or copays and max out-of-pocket.  If lower costs mean the most to you, an HMO will work. If to restrictive or controlling and you want the freedom of choice of your provider, then you should look for PPO plans.

Jeffrey Brucculeri · Answer

I wouldn't refer to any of the details or benefits of an HMO as "disadvantages." However, some of the differences between an HMO and a PPO might be that with an HMO you cannot "electively" decide to see a provider who is out of network. If you go out of network, you will be responsible for the costs. Some HMOs will allow an out of network visit in special circumstances on a case-by-case basis. With some HMOs you may need a referral from your PCP to see a specialist. This is not the case with all HMOs; however, the specialists may require a referral and not the insurance company. Also, with an HMO, you will be covered even while traveling outside your area in the case of an emergency. If you need to go to an urgent care center or emergency room, your HMO will cover you at the same copay as if you were going to a local facility in your home area.

Answered by Jeffrey Brucculeri on March 30, 2026

Agent Licensed in OK, KS, MO & TX

Answered by Jeffrey Brucculeri Medicare Insurance Agent

Jeff Linabary · Answer

An HMO does not allow you to go outside of the Network or you will have higher costs. You may have some limitations to the doctors you can see.

Christine Vassar · Answer

The biggest disadvantage to an HMO is that you have to stay in network and have to have referrals from your primary care doctor for all other care. Additionally, not as many doctors like to accept HMOs.

Answered by Christine Vassar on January 19, 2026

Agent Licensed in GA

Answered by Christine Vassar Medicare Insurance Agent

LeAnn Pedersen · Answer

An HMO plan has a very limited network of doctors it is much smaller than PPO and EPO network and you cannot go out of network or you will be paying the full cost. It is less expensive than a PPO plan so if you can be sure to stay in your network you will be ok.

Answered by LeAnn Pedersen on January 19, 2026

Broker Licensed in MN

Answered by LeAnn Pedersen Medicare Insurance Agent

Chase Strickland · Answer

The two primary disadvantages of an HMO include (1) you may only see in-network providers, and (2) you need a referral to see a specialist.

Rick Valente · Answer

HMO will require you to get a referral from your primary care physician
in order to see a specialist. You will also be required  to use "in-network"
doctors, hospitals, clinics, etc. in order have those visits covered by your plan.

What are disadvantages of HMO?

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