A Health Maintenance Organization, or HMO, is a medical insurance plan that provides coverage for care received from a health care provider---such as a general practitioner, a specialist, a hospital or some other medical facility---in the HMO's network.
The Facts
In general, an HMO may require care to be accessed initially through a primary care physician. In turn, the primary care physician provides care when appropriate, makes referrals to specialists when necessary and coordinates each patient's care.
Costs
HMOs negotiate with providers to supply services at specially negotiated rates. As a result, HMO coverage may cost less than other options and the cost of care to the patient may be limited to a small flat fee---called a copayment.
Considerations
A covered person must use health care providers in the HMO's network or care may not be covered.
Benefits
HMOs typically screen providers for quality before they offer acceptance into the network. HMOs may offer preventive care---such as annual physicals and screenings---received from participating providers at low to no cost.
HMO providers file claims for patients, so there's no paperwork.
Warning
Different HMOs have different rules. To maximize benefits, obtain plan information from the insurance company or employer that offers the HMO.
Tags: care physician, health care, primary care, primary care physician