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A non-government resource, powered by health insurance experts.
A non-government resource,
powered by health insurance experts.

Q: What Is an HMO?

Asked by Anonymous on October 12, 2017

Hal Levy October 12, 2017

An HMO, also known as a Health Maintenance Organization, is one of the most common types of insurance plans.

Limited Network

In HMOs, there’s less separation between medical professionals and your insurance company. If you enroll in an HMO, you’ll be limited to a network of doctors and facilities that are closely linked to the HMO. The medical professionals you see may be direct employees of the HMO.

Focus on Primary Care

In an HMO, you’ll generally have to choose a doctor known as a primary care provider (PCP) that is part of the provider network of the HMO. When you have a medical issue, you’ll visit your PCP. Your PCP will work closely with your insurer. If you need to see a specialist, you’ll often need to get a doctor’s referral from PCP. The specialist you see will be restricted to a doctor within your HMO’s network. You may not need referrals for preventive care. HMO plans must also cover emergency care even outside of the network.

Cheaper Than Other Major Medical Plans

HMOs have more control over its doctors and facilities than other types of plans. HMOs limit the number of providers in their network so as to keep costs down. As such, they’re generally cheaper than comparable plans.

HMOs are one of several types of common health plans – like PPO, EPO, and POS plans – that you may learn more about.

Taking the Next Steps

You can browse with confidence, knowing that you understand the differences between insurance plans available in your area. Use our intelligent plan selection tool to choose an HMO if you prefer, or request an HMO on the phone from one of our affiliated brokers.

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