What is a Health Maintenance Organization (HMO)?

A health maintenance organization (HMO) insurance plan is the most maligned insurance plan on earth, and the one that made us accustomed to the utterance of “managed care.” They’re way back at the monkey’s uncle end of the evolutionary scale. About a third of all Americans who get their insurance through their employers have HMOs.

An HMO is usually the least expensive variety because they’re generally the most restrictive, and most directive as to what your doc and you can do. And sometimes they provide the most preventive care. The plans set up a network of doctors and hospitals that will provide care for you at a very low (or no) cost as long as the plan guarantees a steady stream of patients.

Ah, HMOs. The most maligned health insurance plan on earth, and the one that made us accustomed to the utterance of "managed care." About a third of all Americans who get their insurance through their employers have HMOs as their health insurance providers.

You likely know the drill with HMO plans. They're the least expensive variety because they're generally the most restrictive. 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 doctor) on your own whim and expect the services to be covered. You pay very little (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.

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