When a member joins an Health Maintenance Organization or HMO, he or she chooses a primary care physician. All services are provided or arranged by the primary care physician, including referrals to specialists.
Most services are covered entirely or with small copayments, including many services to keep members well. These include periodic physicals, mammograms, immunizations and routine office visits.
With an HMO, there are usually no deductibles to meet, rarely a claim form to fill out, and out-of-pocket expense is minimal.
HMO Characteristics
The primary care physician acts as a gatekeeper by coordinating all care and referrals.
Contracts join providers and members in a structured fashion.
Member must use network providers. There is choice within the network.
HMOs offer predictable costs and copayments. A fee is charged according to an HMO menu, which offsets cost of paperwork and administration for each office visit and pharmacy prescription filled.
