How to Choose an HMO in the Philippines (2026)

The top HMO providers in the Philippines are Maxicare, MediCard, Intellicare, PhilCare, iCare, and Cocolife Healthcare. Individual plans start as low as ₱999/year (Maxicare PRIMA Consult) for outpatient-only coverage, or ₱3,600/year (MediCard My MediCard) for consultations across multiple specialties. Full inpatient + outpatient HMO coverage typically costs ₱11,000–₱45,000+/year depending on your age and coverage level.

An HMO (Health Maintenance Organization) gives you access to cashless healthcare — consultations, lab tests, hospital stays, dental visits, and more — at accredited facilities across the country. Unlike PhilHealth, which covers only case rate portions of hospitalization, an HMO covers your everyday healthcare needs.

But with multiple providers, confusing plan names, and hidden exclusions, choosing the right HMO can be overwhelming. This guide breaks down every major HMO provider, compares their plans, and gives you a clear framework for choosing.

Quick Comparison

Note: Caritas Health Shield was placed under liquidation by the Insurance Commission effective August 18, 2025. It is no longer accepting new members.

Maxicare — Largest Network

Maxicare is the Philippines' largest HMO by revenue (approximately ₱26 billion in Q4 2023) with 1.8 million members and the widest provider network.

Individual Plans (MyMaxicare)

Annual premiums range from approximately ₱11,000 to ₱45,000+ depending on your age and plan tier. Age limit for MyMaxicare is 60 years old.

Prepaid Health Cards (PRIMA)

For budget-conscious individuals who mainly need outpatient care:

All PRIMA cards activated after January 15, 2026 include free Personal Accident Insurance. Pre-existing conditions are accepted on PRIMA cards.

Telemedicine: 24/7 teleconsultation via Doctor Anywhere app with 18+ specialties.

Mental health: Maxicare was the first Philippine HMO to offer a Specialized Care Program for Mental Health — covering psychiatrist consultations and teleconsult access through their Primary Care Clinics.

MediCard — Most Affordable Plans

Now part of AIA Philippines, MediCard offers the widest range of plan types — from budget outpatient cards to premium VIP coverage.

Plan Lineup

MediCard's Health Plus at ₱1,545/year is the cheapest full-provider HMO plan available — unlimited consultations with no age limit and no medical exam required.

Kabayan Plan (For OFWs)

Pre-existing conditions: VIP plan covers PECs from day one (hypertension, goiter, cataracts, gastritis, TB, arthritis, etc.). Standard plans cover PECs starting on the second year of continuous membership.

Telemedicine: 24/7 via My Pocket Doctor app.

Intellicare — Top Corporate HMO

Ranked #1 among Philippine HMOs by net income (₱503 million in Q2 2025), Intellicare serves 1.2 million+ members through 69,000+ doctors and specialists.

Important: Intellicare primarily serves corporate accounts and does not prominently offer individual consumer plans. If your employer provides Intellicare, you're in good hands. If you're buying on your own, look at Maxicare or MediCard instead.

SME focus: Intellicare Locale offers HMO programs for budget-conscious MSMEs in regional growth centers.

Telemedicine: 24/7 teleconsultation powered by Medgate Philippines, accessible through the Intellicare Agora app.

PhilCare — Best for Mental Health

PhilCare (40 years in operation) is known for being the first Philippine HMO with a fully functional mobile app and for their dedicated mental health coverage.

Mind Care Plus covers:

• 1 teleconsultation with a psychiatrist
• 3 mental health assessments
• 5 chat-based support sessions per year

Digital LOA: PhilCare's app lets you generate a Letter of Authorization (LOA) yourself, without calling a hotline — reducing wait times when you need to see a doctor.

Telemedicine: HeyPhil app — free 24/7 teleconsultation and online doctor appointments.

Pricing: Not publicly listed. Requires a quote through PhilCare directly or through MariaHealth.ph.

iCare (Insular Health Care) — Best for Families

An InLife subsidiary ranked 4th among Philippine HMOs by the Insurance Commission as of December 2025. iCare stands out with family-friendly coverage.

Key features:

• Congenital abnormalities covered up to ₱10,000
• Unlimited dental consultations + unlimited simple tooth extractions
• Maternity and pre/post-natal benefits
• Up to ₱5,000,000 annual hospitalization benefits (family plan)
• Fixed ₱100,000/year outpatient limit (family plan)

iCare offers individual and family plans through their online shop at shop.insularhealthcare.com.ph.

Pacific Cross — Best for Seniors and High Coverage

Important distinction: Pacific Cross is a health insurance company, not a traditional HMO. The key differences: you pay upfront and get reimbursed (no cashless LOA), but coverage extends well beyond what HMOs offer.

Best for: Seniors over 60 (most HMOs cap enrollment at 60), expats, retirees, and anyone wanting coverage beyond HMO limits. Premiums are higher than traditional HMOs — expect approximately ₱12,000+/year and up.

HMO vs. PhilHealth: What's the Difference?

Can you have both? Yes — and you should. Most HMOs actually require active PhilHealth membership. When hospitalized, PhilHealth covers its case rate first, then the HMO covers the rest up to your MBL. Having both dramatically reduces out-of-pocket costs. For a full breakdown of PhilHealth coverage, read our Complete Guide to PhilHealth Benefits.

HMO vs. Health Insurance

The ideal strategy: Have both. HMO handles the frequent, smaller expenses (consultations, lab tests, dental). Health insurance covers rare but financially devastating events (cancer treatment, major surgery, extended hospitalization).

What HMOs Don't Cover (Common Exclusions)

Nearly all Philippine HMOs exclude:

1. Cosmetic/aesthetic surgery (unless for accident-related functional defects)
2. Self-inflicted injuries including tattoo and piercing infections
3. Pre-existing conditions during the waiting period
4. Congenital, genetic, hereditary diseases (some plans cover limited amounts)
5. Infertility treatments
6. Weight management/obesity treatments
7. Dental prosthetics beyond basic coverage
8. Experimental treatments
9. Injuries from hazardous sports, illegal activities, or alcohol/drug use
10. War, terrorism, nuclear-related injuries

Always read the exclusions list before enrolling. An attractive MBL means nothing if your most likely conditions are excluded.

How Employer-Provided HMO Works

Your employer is not legally required to provide HMO — the Philippine Labor Code only mandates PhilHealth contributions. However, most employers offer HMO as a benefit upon regularization (typically after 6 months probation).

Key things to know:

• Your employer usually pays the full premium (sometimes with cost-sharing)
• Dependent coverage (spouse, children, sometimes parents) is often available after regularization
• Non-diminution rule (Article 100, Labor Code): Once your employer consistently provides HMO, it becomes a protected benefit that cannot be unilaterally reduced
• Corporate plans typically cover pre-existing conditions from day one — this is a major advantage over individual plans

If you lose your job or resign, your HMO coverage ends with your employment. Consider getting an individual plan to bridge the gap.

Key Terms You Should Understand

10 Tips for Choosing the Right HMO

1. Check if your preferred hospitals and doctors are accredited before buying any plan
2. Compare MBL vs. ABL — ABL is generally more comprehensive since it's a single cap across all conditions
3. Match your life stage — young singles need less; families with kids need pediatric + maternity
4. Read the exclusions carefully — they matter more than the MBL number
5. Check telemedicine access — all major HMOs now have teleconsult apps, but quality varies. Read our telemedicine app comparison for details
6. Understand PEC policies — if you have existing conditions, look for shorter waiting periods or day-one PEC coverage (MediCard VIP, corporate plans)
7. Consider HMO + insurance combo — HMO for everyday needs, health insurance for catastrophic events
8. Don't forget dental and mental health — these are often add-ons, not included in base plans
9. Ask about renewal terms — some HMOs decline renewal after major claims
10. If you're 60+ — options are limited. MediCard Health Plus has no age limit; otherwise consider Pacific Cross health insurance

Find an HMO-Accredited Clinic Near You

Already have an HMO and need to find an accredited clinic? Search on ClinicFinderPH — filter by location, specialty, and HMO coverage to find clinics that accept your plan.

Frequently Asked Questions

How much does an HMO cost in the Philippines?

HMO costs vary widely depending on the provider, plan tier, and your age. Budget outpatient-only plans start at ₱999/year (Maxicare PRIMA Consult) or ₱1,545/year (MediCard Health Plus). Full inpatient + outpatient coverage typically ranges from ₱11,000 to ₱45,000+/year for individual plans. Corporate/employer plans are usually cheaper per person because the risk is spread across a group.

What is the best HMO in the Philippines?

There is no single "best" HMO — it depends on your needs. Maxicare has the largest network (1,300+ hospitals, 20,000+ doctors). MediCard offers the most affordable entry plans and the best OFW coverage. Intellicare is the top-performing corporate HMO. PhilCare leads in mental health coverage. For seniors over 60, MediCard Health Plus (no age limit) or Pacific Cross health insurance are the best options.

Is HMO mandatory for employees in the Philippines?

No. The Philippine Labor Code does not require employers to provide HMO coverage — only PhilHealth contributions are mandatory. However, most companies offer HMO as a benefit upon employee regularization. Once consistently provided, HMO becomes a protected benefit under the non-diminution rule (Article 100, Labor Code) and cannot be unilaterally removed by the employer.

What is the difference between HMO and PhilHealth?

PhilHealth is mandatory government health insurance that covers hospitalization case rates. An HMO is private prepaid healthcare covering consultations, lab tests, dental, and more at accredited facilities. You can — and should — have both. When hospitalized, PhilHealth covers its portion first, then your HMO covers the rest up to your maximum benefit limit, significantly reducing your out-of-pocket costs.

Does HMO cover pre-existing conditions?

It depends on the plan. Most individual HMO plans enforce a waiting period of 6–24 months before covering pre-existing conditions. MediCard VIP covers PECs from day one (hypertension, goiter, cataracts, gastritis, TB, arthritis, etc.). Corporate/employer plans typically cover PECs 100% from day one with no waiting period — this is one of the biggest advantages of employer-provided HMO.

What happens to my HMO when I resign?

Your employer-provided HMO coverage ends with your employment — typically on your last working day or at the end of the month. You should either enroll in an individual HMO plan immediately to maintain coverage, or check if your HMO provider offers a conversion option from corporate to individual membership. Do not leave yourself uninsured during the transition.

What is MBL in HMO?

MBL stands for Maximum Benefit Limit — the maximum amount your HMO will pay for a single illness or condition per year. For example, if your MBL is ₱100,000 and your hospital bill is ₱150,000, you'll need to pay the remaining ₱50,000 out of pocket (after PhilHealth's case rate portion). Unused MBL does not carry over to the next year. Some plans use ABL (Annual Benefit Limit) instead, which is a single cap covering all claims regardless of condition.

Can senior citizens get an HMO in the Philippines?

Options are limited but available. MediCard Health Plus (₱1,545/year) has no age limit and provides outpatient coverage. Pacific Cross offers health insurance plans that can cover ages up to 80–100. Most traditional HMO plans cap enrollment at 60–65 years old. For a full breakdown of available coverage options, also check our PhilHealth Benefits Guide — PhilHealth has no age limit and significantly expanded benefits in 2025.

Last updated: March 2026. HMO plans, pricing, and coverage may change. Contact providers directly for the latest rates and plan details.