What Is a HMO (Health Maintenance Organization)?
HMO plans require you to choose a primary care physician who coordinates your care. You need referrals to see specialists, and out-of-network care is generally not covered except in emergencies. HMOs typically have the lowest premiums of any plan type.
Best for: people who want lower premiums and are comfortable using a primary care physician for coordination and referrals.
Watch out for: HMOs can be restrictive if you have established specialist relationships or may need care outside your local area. Always confirm your specific doctors are in the HMO network before enrolling.
HMO Plans Available in Wisconsin
The following carriers offer HMO health insurance plans in Wisconsin for 2026: Common Ground Healthcare, Dean Health Plan, Security Health Plan, Medica, WPS Health Insurance.
The dominant carrier in most Wisconsin counties is Common Ground Healthcare Cooperative.
Wisconsin uses a unique BadgerCare Plus model that covers adults to 100% FPL. Between 100-138% FPL, Wisconsin residents get marketplace subsidies. Wisconsin has NOT formally expanded Medicaid.
Plan availability and premium amounts vary by ZIP code and county. Rural counties often have fewer
carrier options than major metro areas. Always compare all plans available in your specific ZIP code
rather than shopping by carrier name alone.
How to Compare HMO Plans in Wisconsin
When comparing HMO plans in Wisconsin, look at:
- Network: Confirm your doctors and preferred hospitals are in the plan’s network
- Deductible: How much you pay before insurance starts covering costs
- Out-of-pocket maximum: The most you’ll pay in a plan year
- Premium: Your monthly cost after any applicable ACA subsidies
- Drug formulary: Whether your prescription medications are covered at a preferred tier
An independent broker compares all Wisconsin marketplace plans in your ZIP code without charging fees.