What is an HMO or Health Maintenance Organization?

HMOs are the oldest form of managed care plan. In an HMO, your coverage is paid in advance instead of paying separately for each service that you receive. This is called prepaid care.

For a set monthly fee, HMOs offer members a range of health benefits including preventive care. There are many kinds of HMOs. If doctors are employees of the health plan and you visit them at central medical offices or clinics, it is a staff or group model HMO. Other HMOs contract with physician groups or individual doctors who have private offices. These are called individual practice associations (IPAs) or networks.

HMOs will give you a list of doctors from whom you choose a primary care physician. The primary care physician coordinates your care which means that generally you must contact him or her to be referred to a specialist. Typically, with most HMOs there is a copayment for office visits, hospitalizations and other health services.

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