Health maintenance organization

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Health maintenance organizations, or HMOs, are insurance groups that provide health services for an annual fee. An HMO plan usually limits coverage to specific medical providers that are part of or contract with the HMO.^[1][2]

Overview[edit]

Health maintenance organizations are groups of affiliated insurers and medical providers. Typically, an HMO insurance plan will limit coverage to providers that are members of or contract with the HMO, not covering out-of-network services. HMOs often require an individual to work or live in a certain area to receive coverage and tend to provide wider coverage than other plans, such as preventative care. However, an HMO plan may prevent a patient from seeing a specialist if none are available as part of the HMO without paying out of pocket for the service. Payments to HMO plans are fixed without regard to the actual services rendered to an insured member. In an HMO plan, a patient typically sees one primary care physician for all their health care services, and only visits another via a referral from the primary physician.^[1][2][3][4]

See also[edit]

• Obamacare overview
• History of healthcare policy in the United States
• Preferred provider organization

External links[edit]

• Healthcare.gov glossary
• Medical Mutual, PPO & HMO Health Plan Differences

Footnotes[edit]