What Is An HMO?

If you're looking for a health plan that's easy to understand, easy to use and easy on your wallet, an HMO may be just what you need for you and your family.

It's Care. Simplified.

An HMO, or Health Maintenance Organization, is designed to keep costs low and predictable. With one doctor to coordinate your care, an HMO health plan is easy to use and may be just what you’re looking for.

With an HMO health plan, you’ll have:

  • Monthly premiums, copays and deductibles are often lower than other types of plans.
  • Access to certain doctors and hospitals in the HMO provider network. This helps control the fees you are charged for care.
  • A primary care physician — your personal doctor — who helps make sure you get the care you need.

HMO. It's Personal.

An HMO health plan is personalized to meet your health care needs. Your primary care doctor, or PCP, will be your partner in keeping you healthy. He or she will get to know you, your health history, medications and lifestyle and make sure you get the right care at the right time.

Getting Started

When you first sign up for an HMO health plan, you choose, or are assigned, a primary care physician (PCP). Each family member on your plan can have their own PCP. PCPs can be doctors who practice:

  • Family medicine
  • OB/GYN
  • Geriatrics
  • Pediatrics

Your PCP is listed on the front of your Blue Cross and Blue Shield of New Mexico (BCBSNM) member ID card or you can find it when you log in to your Blue Access for MembersSM account. If you’re new to HMOs and need a new doctor, view our helpful hints for finding a new doctor.

How do I Change my PCP?

You can change your PCP at any time, except if you are hospitalized or in the 2nd or 3rd trimester of pregnancy.

Online

  • Log in to Blue Access for Members
  • Choose the Change PCP link
  • Follow the instructions

By Phone

Call BCBSNM Customer Service at the number listed on your BCBSNM member ID card.

HMO. It's Coordinated.

HMO health plans are designed to help you stay healthy. Having one health care expert — your PCP — to coordinate all your health care needs keeps your costs and your health on track. An early diagnosis and treatment can keep many common health issues from getting worse.

Year after year, BCBSNM HMO health plans have proven to help improve member health results and lowered their overall cost of care because health issues are managed before they get serious. People with chronic conditions such as asthma and diabetes have seen the greatest results.

Working with Your PCP

Think of your PCP as your personal care doctor. Follow these guidelines to make the most of your relationship:

  • Meet Your PCP. If you’re a new patient, make an appointment to see your PCP to help avoid delays later when you are sick or need a referral. Be sure to tell the office that you're a new patient.
  • Referrals to Specialists. You don't need a referral to see a specialist as long as you choose a provider in the HMO network. You also don't need a referral to visit a hospital. If you're not sure who to see, ask your PCP and they can refer you to a provider. You don't need referrals for mammograms, OB/GYN and behavior health services, as long as they are in the HMO network. 
  • For Non-Emergencies. See your PCP first for minor illnesses like a cold, flu, minor cuts or burns. If the office is closed, call the doctor's after-hours number. They will either try to fit you in or refer you to another doctor or clinic. In some cases, they may have you go to the hospital.
  • For Emergencies. For life-threatening illnesses or injuries, call 911 or go to the nearest emergency room. You don't have to go in-network or get a referral. But do tell your PCP about your emergency as soon as you can so they can follow your treatment and manage any follow-up care.

HMO. It's Affordable.

HMO health plans are designed to control costs while keeping you healthy. Most of your costs are your monthly premiums, copays and a set deductible. HMOs are also a lower-cost option because doctors and hospitals in the HMO provider network agree to offer their services at a set price.

If you go to a provider who is not in your network, you may have to pay the entire bill. This is because providers set their own prices for their services, which vary by a few hundred to thousands of dollars. Because out-of-network providers don't have a contract with us, we can't control how much they charge you. So to avoid big bills, make sure you stay in the HMO provider network.

Search Provider Finder® for Doctors and Hospitals in the HMO Network

Provider Finder makes it easier to find a doctor or hospital in the HMO network. If you're a BCBSNM member, log in to Blue Access for Members for personalized results based on your health plan and network. Provider Finder also has a cost estimator to help you find costs for health visits, procedures, surgeries, diagnostics and imaging, vaccinations/immunizations and other services.

Helpful hint: No matter which plan you have, before you need care, get to know your plan, what's covered and where you can go for care. Knowing how your plan works may save you time and money. Learn more about Making Insurance Work For You.

View Plans

BCBSNM policies have exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call BCBSNM at 1-866-445-1396 or contact your independent, authorized broker.

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