Individual and Family
Health Maintenance Organization (HMO) Plans

Call 866.631.4611 for questions or to speak to someone about a plan.

2024 Special Enrollment Quote/Apply

HMO plans that fit your lifestyle

An HMO gives you access to doctors and hospitals within its network. A primary care practitioner (PCP) can help coordinate your overall medical care. No matter which HMO plan you choose you will receive:

  • 100% coverage for preventive services completed by an in-network provider
  • $0 copay on preventive drugs that target common medical conditions
  • 24/7/365 video visits for general medical, dermatology and behavioral health through MDLive
  • Access to our RN Comprehensive Care Coordination team
  • FREE Nurseline 24/7/365
  • Access to Hear in America
  • Tobacco Cessation coverage

Is my doctor in the network?

Aspirus offers 13 regional hospitals in Wisconsin and 4 more in the Upper Peninsula of Michigan, over 75 clinics and more than 400 physicians.

With an HMO plan, there is no referral necessary to see an in-network specialist, but some services will require review and prior authorization. If you receive care from an out-of-network provider, the HMO will not pay for that care unless the condition was deemed an emergency or approved prior authorization is received from Aspirus Health Plan.

Search for care within my network

Search Network

2024 HMO health plans at a glance

2024 Plan Details – Contracts, Plan Summaries and Summary of Benefits and Coverage (SBCs).

HMO Gold (two options)

Individual deductible
$1,500 or $2,400

Individual out-of-pocket maximum
$8,700 or $6,500

Family deductible
$3,000 or $4,800

Family out-of-pocket maximum
$17,400 or $13,000

Coinsurance
25%-30%

Office visits
$0 - $30, $60 Speciality

HMO Silver (two options)

Individual deductible
$5,900 or $7,500

Individual out-of-pocket maximum
$9,100 or $8,400

Family deductible
$11,800 or $15,000

Family out-of-pocket maximum
$18,200 or $16,800

Coinsurance
40% or 30%

Office visits
$0 - $40, $80 Speciality

HMO Bronze (three options)

Individual deductible
$0 or $7,500 or $9,450

Individual out-of-pocket maximum
$9,450 or $9,400 or $9,450

Family deductible
$0 or $15,000 or $18,900

Family out-of-pocket maximum
$18,900 or $18,800 or $18,900

Coinsurance
50% or 50% or 0%

Office visits
$35-50 or $200 Speciality

HMO Catastrophic

Individual deductible
$9,450

Individual out-of-pocket maximum
$9,450

Family deductible
$18,900

Family out-of-pocket maximum
$18,900

Coinsurance
0%

Office visits
0% after deductible

HMO HSA Silver

Individual deductible
$5,400

Individual out-of-pocket maximum
$5,400

Family deductible
$10,800

Family out-of-pocket maximum
$10,800

Coinsurance
0%

Office visits
0% after deductible

HMO HSA Bronze (two options)

Individual deductible
$6,250 or $7,200

Individual out-of-pocket maximum
$7,250 or $7,200

Family deductible
$12,500 or $14,400

Family out-of-pocket maximum
$14,500 or $14,400

Coinsurance
30% after deductible or 0% after deductible

Office visits
$0 after deductible