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What Is An HMO?

A Health Maintenance Organization (HMO) is a type of managed care plan that provides health care through a network of contracted health care facilities and providers like physicians, dentists, hospitals and pharmacies.

HMOs are considered to be the simplest and perhaps most affordable type of health insurance plan. Members enrolled in an HMO pay a monthly premium for their coverage. Minimal co-payments (approx. $20 or so) apply when members access medical services like doctor visits, inpatient medical care or outpatient surgery.

Members select a primary care physician (PCP) who will act as their main doctor and gatekeeper. This is because prior to seeking treatment from a specialist, the member first  needs to get a referral from the PCP.

HMO members can only get their care from in-network health care providers. Going out of network for care will not be covered and members will have to pay 100% for the cost.

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