Managed Care Insurance

How does a Health Maintenance Organization (HMO) work?

A Answers (2)

  • AMichael Roizen, MD, Internal Medicine, answered

    An HMO, Health Maintenance Organization, is usually the least expensive variety because it’s generally the most restrictive, and most directive as to what your doc and you can do. Although many different versions exist now, in the traditional HMO, you must pick a primary care doctor who is in the HMO network of physicians, and this doctor coordinates all of your care. That doctor must refer you to specialists who are generally also in the HMO network; you can’t just go see them (or any out-of-network doc) on your own whim and expect the services to be covered. You pay next to nothing (or nothing) for in-network care, meaning the care or services you receive from one of the hospitals or doctors who have agreed to accept greatly reduced payments from the HMO’s members. But if you see a doctor outside the HMO network, or break the rules, you pay 100% of the costs.

  • AUnitedHealthcare answered
    With a Health Maintenance Organization (HMO), your primary care physician, also known as a gatekeeper, serves as your health care advocate and will help you find the best treatment for physical and mental health problems you might face.  With a typical HMO, you (or your employer) pay a monthly premium for coverage and you pay a co-payment for each office visit. You are usually covered for general physical exams and other kinds of services. Some HMOs have big medical clinics, with doctors, nurses and therapists on staff. You typically choose a physician from the organization’s list to coordinate your medical treatment. HMOs tend to provide the least expensive medical coverage and a minimum of paper work. However, your choice of physicians may be more limited.
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What is a Health Maintenance Organization (HMO)?