What Makes an HMO an HMO?

Health Maintenance Organizations or HMOs are prepaid managed care plans that allow you to take advantage of the services of its hospitals, clinics and participating physicians— with a big emphasis on preventative medicine.

HMO’s require that you choose what’s known as a primary care physician or “PCP” from your insurance carriers’ list of their in-network healthcare providers. The primary care physician you select will be responsible for managing every aspect of your healthcare. If you need treatment from a network provider other than your primary physician, you’ll probably need to get a referral from your primary physician to see them.

Be sure to find out if your plan includes a "gatekeeper" clause that will give your primary care physician control over access to other providers in your HMO’s network.

If it turns out that your plan does have a "gatekeeper" clause, you’ll have to obtain care exclusively from your in-network providers to be sure your claim will be paid by your HMO. If you join an HMO Plan, you’ll wind up paying a flat amount for most medical services.