HMO – Health Maintenance Organizations

With a health maintenance organization (HMO), instead of paying for each individual service that you receive, you pay a set monthly or quarterly premium. In return, HMOs offer you a range of health benefits, including preventive care.

With an HMO, you choose a primary care physician affiliated with your plan, usually a general practitioner, to coordinate your care. Generally, you must receive a referral from your primary care physician before visiting a specialist in your provider network. With rare exceptions, your HMO will require that you seek care within its network of providers ­ doctors, hospitals, and labs — with whom your HMO has negotiated a fee schedule. Negotiating discounts from providers is one of the main ways HMOs keep healthcare costs in check.

In addition to your monthly or quarterly premiums, most HMOs require a copayment for certain services, for example, $10 or $20 for an office visit. Some, but not all, HMOs will apply copayments to hospitalizations as well.

One of the interesting things about HMOs is that they deliver care directly to patients. Patients may to go to an HMO’s medical facility to see the nurses and doctors. Another common model is a network of individual practitioners. In these individual practice associations (IPAs), you will get your care in the office of a physician who may accept patients from different health plans.

Here at Santa Barbara Health Insurance Services we know that no web site can substitute for courteous service from an experienced professional. Our staff is always happy to help with your California health insurance, California dental insurance, or term life insurance needs. Feel free to call us any time at (800) 765-1540.