Health Maintenance Organization (HMO) Definition

A Health Maintenance Organization (HMO) is a type of managed care organization that provides healthcare services through a network of contracted healthcare providers, including primary care physicians, specialists, hospitals, and other healthcare facilities. Under an HMO plan, members typically choose a primary care physician (PCP) from within the HMO network who coordinates their healthcare and refers them to specialists or hospitals within the network as needed.

HMOs emphasize preventive care and often require members to obtain referrals from their PCP for specialist consultations or non-emergency medical services to control costs and ensure coordinated care. HMOs generally have lower out-of-pocket costs for members but require them to use healthcare providers within the network to receive coverage for non-emergency services. This model aims to provide cost-effective healthcare by emphasizing preventive care, managing chronic conditions, and coordinating healthcare services within a defined network of providers.