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
2025 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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2025 HMO health plans at a glance

2025 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
$7,800 or $6,250

Family deductible
$3,000 or $4,800

Family out-of-pocket maximum
$15,600 or $12,500

Coinsurance
25%-30%

Office visits
$0 - $30, $60 Speciality

HMO Silver (two options)

Individual deductible
$5,000 or $6,600

Individual out-of-pocket maximum
$8,000 or $7,500

Family deductible
$10,000 or $13,200

Family out-of-pocket maximum
$16,000 or $15,000

Coinsurance
40% or 30%

Office visits
$0 - $40, $80 Speciality

HMO Bronze (two options)

Individual deductible
$0 or $7,500

Individual out-of-pocket maximum
$9,200 or $9,200

Family deductible
$0 or $15,000

Family out-of-pocket maximum
$18,400 or $18,400

Coinsurance
50% or 50%

Office visits
$35-50 or $200 Speciality

HMO Catastrophic

Individual deductible
$9,200

Individual out-of-pocket maximum
$9,200

Family deductible
$18,400

Family out-of-pocket maximum
$18,400

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

Individual deductible
$7,200

Individual out-of-pocket maximum
$7,200

Family deductible
$14,400

Family out-of-pocket maximum
$14,400

Coinsurance
0%

Office visits
$0 after deductible