HMO - Health Maintenance Organizations


What is an HMO plan?

HMO means "Health Maintenance Organization." HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan.

How does an HMO plan work?

As a member of an HMO, you'll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP.

Though there are many variations, HMO plans typically enable members to have lower out-of-pocket healthcare expenses. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. You also typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage for services rendered by out-of-network providers or for services rendered without a proper referral from your PCP.

An HMO plan may be right for you if:

  • You're shopping for a plan with lower premiums.

  • You want a plan without a deductible and don't mind having an out-of-pocket limit.

  • You need preventive care services such as coverage for checkups and immunizations.


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