# Medicare HMOs > A Medicare HMO is a Medicare Advantage plan run as an HMO: members use the plan's network of doctors and hospitals, except in emergencies, and pick a PCP. Source: https://dmand.ai/glossary/medicare-hmo · Last updated: 2026-10-17 [Glossary](https://dmand.ai/glossary) Updated Oct 17, 2026 1 min read [Copy as Markdown](https://dmand.ai/glossary/medicare-hmo.md) Definition A Medicare HMO is a Medicare Advantage plan structured as a health maintenance organization. Members generally must use the plan's network of doctors and hospitals, except in emergencies, and usually choose a primary care provider who coordinates their care and refers them to specialists. HMOs are the most common type of Medicare Advantage plan. Medicare HMOs are private plans that contract with [Medicare](https://dmand.ai/glossary/medicare) to provide benefits. Members typically use the plan's network, with a [primary care provider (PCP)](https://dmand.ai/glossary/primary-care-provider-pcp) who manages their care and makes specialist referrals. ## What are the key features of Medicare HMOs? - **Network rules:** most services must come from in-network providers - **Referrals:** members usually need a PCP referral to see a specialist - **Emergency exceptions:** emergency and urgently needed care is covered out of network ## How do Medicare HMOs control costs? They manage a network of contracted providers, coordinate care through the PCP and emphasize prevention. In exchange for less choice, members often pay lower premiums and cost sharing than in other Medicare Advantage plans such as PPOs. ## How do Medicare HMOs differ from other Medicare plans? Original Medicare lets members see any provider that accepts Medicare. Medicare HMOs limit coverage to the network except in emergencies. Medicare PPOs also cover out-of-network care, at a higher cost. ## What Medicare HMOs mean for teams selling into healthcare Medicare HMOs depend on coordinated care, so they buy care management, network management and member engagement tools, and they work closely with the medical groups in their network. Many of those groups take on financial risk for HMO members, which makes them buyers of population health tools too. ## Terms related to Medicare HMOs - [Medicare Advantage Medicare Advantage, also called Medicare Part C, lets beneficiaries receive their Medicare benefits through a private health plan approved by Medicare instead of Original Medicare.](https://dmand.ai/glossary/medicare-advantage) - [PCP Primary Care Provider A primary care provider (PCP) is the clinician a patient sees first for routine care, prevention and common health problems, and who coordinates referrals to specialists.](https://dmand.ai/glossary/primary-care-provider-pcp) Newsletter Free, on Substack Selling Into Healthcare How US health systems, hospitals and practices buy, written for the teams that sell to them. - Org structures - Buyer maps - Data playbooks - Outbound - Market notes [Issue 1 · Latest The healthcare sales map was wrong. So we drew a new one.](https://dmand.ai/blog/healthcare-sales-map) Find the decision makers at every health system you sell into 7.4M+ HCPs and 11M+ executives, mapped down to each site of care. [Start free trial](https://app.dmand.ai/signup?from=glossary&src=glossary%3A%2Fglossary%2Fmedicare-hmo&cta=rail_cta) 30 days free · Self-serve · No credit card Medicare HMOs See where Medicare HMOs shows up on the accounts you sell to Search 7.4M+ HCPs and 11M+ executives at 997K+ sites of care, each placed under its health system and IDN. [Start free trial](https://app.dmand.ai/signup?from=glossary&src=glossary%3A%2Fglossary%2Fmedicare-hmo&cta=closing_cta) [Book a demo](https://dmand.ai/book-a-demo) - 30 days free - Self-serve - No credit card