Understanding HMO Health Insurance Plans | [Your Brand]

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.