An HMO (Health Maintenance Organization) is an association
of healthcare professionals and medical facilities that sell a fixed
package of health care services for a fixed price. Each patient
has a primary care physician, who is often referred to as a gatekeeper
because services provided by a specialist are not covered unless
the gatekeeper determines that the specialist is necessary. If a
specialist is necessary, a referral by the primary care physician
is then made.
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Advantages of HMOs
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Disadvantages of
HMOs
|
| Claim forms aren't usually necessary. |
Services provided by healthcare professionals
outside the network aren't covered. |
| Your out-of-pocket costs are often lower and more
predictable. |
Services provided by specialists require a referral
from your primary physician. |
| |
Some services may be limited. It is important
to check with your insurance plan for a list of your individual
benefits. |
