What Is An HMO? Understanding HMO Insurance Plans (2024)

FAQs

What Is An HMO? Understanding HMO Insurance Plans? ›

How a Health Maintenance Organization (HMO) Works. HMOs provide health insurance coverage for a monthly or annual fee. An HMO limits member coverage to medical care provided through a network of doctors and other healthcare providers who are under contract with the HMO.

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.

A Health Maintenance Organization (HMO) is a prepaid group health plan, where members pay in advance for the services of participating physicians and hospitals that have agreements.

There are many examples of HMOs, both in the public and private sectors. Popular HMO plans can be found in State Health Insurance Assistance Program, Kaiser Permanente, Humana, Medicare, Federal Employees Health Benefits Program, and Aetna.

The purpose of a Health Maintenance Organization is to provide integrated and preventative care while keeping costs low. HMOs rely on in-network physicians to refer their patients to the right specialists and receive the well-rounded care they need.

A house in multiple occupation ( HMO ) is a property rented out by at least 3 people who are not from 1 'household' (for example a family) but share facilities like the bathroom and kitchen.

HMOs (health maintenance organizations) are typically cheaper than PPOs, but they tend to have smaller networks. You need to see your primary care physician before getting a referral to a specialist. PPOs (preferred provider organizations) are usually more expensive.

HMO plans are generally less expensive than PPO plans, with lower monthly payments, making them ideal if your favorite doctors are already in the network, or if you receive most of your care close to home.

Today, approximately 15.2 million Medi-Cal beneficiaries in all 58 counties receive their health care through five main models of managed care: Two-Plan, County Organized Health Systems (COHS), Geographic Managed Care (GMC), Regional Model (RM), and Single-Plan.

There are four basic models of HMOs: group model, individual practice association (IPA), network model, and staff model.

What is one disadvantage of HMOs? ›

On major disadvantage is that it is difficult to get any specialized care because the members must get a referral first. Any kind of care that is sought that is not a referral or an emergency is not covered.

In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month. This is considered by some to be the first example of an HMO.

Health Maintenance Organizations (HMOs) - With a typical HMO plan, you are covered for care from providers in your network only. A referral from your primary care physician (PCP) is required to see a specialist. You usually pay less than for other plans but an HMO may have a smaller network of providers.

HMO. An HMO is a health maintenance organization. The Department of Managed Health Care (DMHC) oversees all HMOs in California and some other kinds of health plans. An HMO is a kind of health insurance that has a list of providers, such as doctors, medical groups, hospitals, and labs.

HMOs have their own network of doctors, hospitals and other healthcare providers who have agreed to accept payment at a certain level for any services they provide. This allows the HMO to keep costs in check for its members. There are 2 features that set HMOs apart from other types of healthcare plans: cost and choice.

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

Doctors often prefer PPOs because they offer greater reimbursem*nt rates compared to HMOs and have less administrative paperwork. Is a PPO a good thing? For many, a PPO's flexibility and coverage make it a favorable choice, but it comes with higher premiums.

You must have a referral to see a specialist or get most other services. Your HMO or medical group must approve many of your services before you can get them. Usually it is your primary doctor who gives you a referral and asks for pre-approval.