Plans & Coverage
Medicare HMO Plans
An HMO (Health Maintenance Organization) is a type of Medicare Advantage plan that keeps premiums and copays low by using a defined provider network and, usually, requiring referrals to see specialists. If your doctors are in the network and you don't travel often, an HMO can be the best value.
Pros and cons
Pros: low or $0 premiums, predictable copays, often strong extra benefits. Cons: you generally must use in-network providers (except emergencies) and may need referrals. Always confirm your La Crosse-area providers are in-network.
Questions, answered
What happens if I see an out-of-network doctor on an HMO?
Except for emergencies and urgent care, out-of-network care usually isn't covered on an HMO — you'd pay full cost. That's why network checks matter.
Do I need a referral to see a specialist on an HMO?
Usually yes — most Medicare HMO plans require you to get a referral from your primary care provider before seeing a specialist. Some plans offer an HMO-POS variant that allows limited out-of-network access without a referral, at a higher cost.
Can I switch from an HMO to a PPO later?
Yes — you can change plans during the Annual Enrollment Period (Oct 15–Dec 7) each year, or during the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31) if you're already in a Medicare Advantage plan. We review your network needs every fall.
Are Gundersen and Mayo both in-network on HMO plans in the La Crosse area?
It depends on the specific plan — HMO networks are narrower by design, and not every HMO includes both health systems. We confirm your specific doctors and hospital are in-network before you enroll.
Talk to a local La Crosse area advisor
Free, no pressure — we compare your options for you.