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HMO Definition

by Ben Bontekoe
  • Overview

    A health maintenance organization (HMO) is a network of physicians and hospitals contracted to provide health care services to the HMO's customers. HMOs emphasize preventative care, believing that regular doctor visits will result in lower health care costs in the long run.
  • Function

    An HMO requires you to select a primary care physician (PCP), who coordinates all of your medical care. You must get a referral from your PCP before visiting a specialist.
  • Features

    An HMO requires only small co-payments for each doctor visit. If you visit a doctor or hospital outside the network, you will be responsible for most or all of the cost.
  • Benefits

    HMOs generally have lower premiums than other types of health insurance. They generally offer a large selection of doctors and cover a wide variety of services.
  • Considerations

    If you or a family member has a condition, like asthma, that requires frequent visits to specialists, you will have to obtain a referral from your PCP before each visit.
  • Warning

    If your doctor does not belong to the network, or leaves the HMO, you will have to select a new PCP or pay much higher costs to continue using her.

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