Individual and Family
Health Maintenance Organization (HMO) Plans

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

2025 Special Enrollment Quote/Apply
2026 Open 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.

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2026 HMO health plans at a glance

2026 Plan Details – Contracts, Plan Summaries and Summary of Benefits and Coverage (SBCs).

HMO Gold (two options)

Individual deductible
$2,000 or $2,700

Individual out-of-pocket maximum
$8,200 or $7,000

Family deductible
$4,000 or $5,400

Family out-of-pocket maximum
$16,400 or $14,000

Coinsurance
25%-30%

Office visits
$0 - $30, $60 Speciality

HMO Silver (two options)

Individual deductible
$6,000 or $6,600

Individual out-of-pocket maximum
$8,900 or $8,600

Family deductible
$12,000 or $13,200

Family out-of-pocket maximum
$17,800 or $17,200

Coinsurance
40% or 30%

Office visits
$0 - $40, $80 Speciality

HMO Bronze (two options) Now HSA eligible

Individual deductible
$0 or $7,500

Individual out-of-pocket maximum
$10,600 or $10,000

Family deductible
$0 or $15,000

Family out-of-pocket maximum
$21,200 or $20,000

Coinsurance
50% or 50%

Office visits
$35-50 or $200 Speciality

HMO Catastrophic Now HSA eligible

Individual deductible
$10,600

Individual out-of-pocket maximum
$10,600

Family deductible
$21,200

Family out-of-pocket maximum
$21,200

Coinsurance
0%

Office visits
0% after deductible

HMO HSA Silver

Individual deductible
$5,900

Individual out-of-pocket maximum
$5,900

Family deductible
$11,800

Family out-of-pocket maximum
$11,800

Coinsurance
0%

Office visits
0% after deductible

HMO HSA Bronze

Individual deductible
$10,000

Individual out-of-pocket maximum
$10,000

Family deductible
$20,000

Family out-of-pocket maximum
$20,000

Coinsurance
0%

Office visits
$0 after deductible