Common misconceptions about HMO plans

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"I won't be able to get the kind of care I need."

"I can't make an appointment with the doctor I want to see."

"I won't have any out-of-state coverage."

Are these types of statements about a health maintenance organization (HMO) plan swirling in your head?

An HMO plan gives you access to doctors and hospitals in a specific area and only covers out-of-network care in emergencies. You might also hear an HMO plan referred to as a state-based plan. It's no secret that HMO plans of the past had a bad reputation. And, with so many misconceptions about this type of plan, it's no wonder there's confusion. So, let's set the record straight.

Top six HMO myths

Myth: HMO plans don't have many providers, so I won't be able to go to my local doctor.

Fact: If you have a state-based HMO plan and need care in Iowa, there's a good chance you're covered.

The HMO coverage area spans all of Iowa's 99 counties, including 100 percent of hospitals in the state and 98 percent of doctors. Plus, some providers in the counties that border Iowa are considered in-network, too.¹

HMO plans come in all shapes and sizes. One of the best ways to keep your health care costs down is to choose an in-network provider. Find a doctor by logging in to myWellmark^®.

Myth: HMO plans don't cover any chiropractor visits.

Fact: In-network chiropractors are covered on Wellmark's HMO plans.

Almost 400 chiropractors are in Wellmark's state-based HMO plans. Log in to myWellmark to find one in your area.

Myth: I need a referral from my primary care provider, also known as a primary care provider (PCP), any time I want to see a specialist.

Fact: HMO plans may not always require a referral.

You may be able to go to any in-network provider — including specialists and chiropractors — without a PCP referral and without paying extra. That means an HMO plan can give you the freedom to go to any in-network provider directly. Just be sure to log in to myWellmark to check your benefits before receiving services.

Myth: HMO out-of-network coverage doesn't provide benefits in the event of an emergency.

Fact: With an HMO, emergency care is covered if you're traveling outside of Iowa.

If you're experiencing a medical emergency, it's important that you get the care you need. That's why HMO plans still provide out-of-network coverage in the event of an emergency. As a Wellmark Blue Cross and Blue Shield member, you have nationwide access to more than 96 percent of hospitals and 95 percent of doctors and specialists.² Log in to myWellmark to find a participating hospital in your area.

If you're feeling a little under the weather while traveling and want to avoid an emergency room visit, check out the Doctor On Demand^® app, where you can see and talk with a board-certified doctor. Your virtual doctor can treat most common medical conditions, and even prescribe medication if needed. A virtual visit through Doctor On Demand is an affordable option covered by some Wellmark plans. You can also purchase a virtual visit without using your insurance information.

Myth: HMOs never allow access to out-of-network providers and services.

Fact: If you have an HMO, out-of-network care may still be available with special approval.

If the care you need is not available within the HMO coverage area, talk to your in-network provider about making a request for out-of-network care. This can be done on your behalf before receiving out-of-network care.

Myth: HMOs don't work for families with college students and snowbirds.

Fact: Dependent children attending college, long-term travelers and families living apart may be covered through guest membership.

Guest membership provides benefits for eligible people living out of state for at least 90 days, but you have to sign up before leaving.

Need more explanation about health insurance and how it works? Take a few minutes to get the health insurance basics and understand your coverage.