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What Is Health Maintenance Organization Health Insurance?
Home » Insurance » Health Insurance » What Is Health Maintenance Organization Health Insurance?Health maintenance organizations are prepaid health plans. As an HMO member, you pay a monthly premium and the HMO provides comprehensive care for you and your family, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy. The HMO arranges for this care either directly in its own group practice or through doctors and other health care professional under contract. Your choices of doctors and hospitals are usually limited to those that have agreements with the HMO to provide care.
There may be a small co-payment for each office visit. Your total medical costs will likely be lower and more predictable in an HMO than with fee-for-service insurance. Because HMOs receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health for problems before they become serious. HMOs typically provide preventive care, such as office visits, immunizations, well-baby checkups, mammograms, and physicals.
In almost all HMOs, you are either assigned or you choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You cannot usually see a specialist without a referral from your primary care doctor who is expected to manage the care you receive.
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