What is an HMO and how does it work?
A Health Maintenance Organization (HMO) is a group of contracted medical providers in which members of the HMO may seek medical services at a pre-negotiated rate. It is a comprehensive prepaid health care service. Generally, there are no deductibles, but most plans require co-pay for services. One usually must choose a Primary Care Physician from the plan’s Provider Directory and/or a network. The Primary Care Physician (PCP) will act as a “Gatekeeper” for all of one’s medical needs. The PCP will become the primary contact and they will refer a patient to other providers or specialists within the network. With most HMO’s, there is no out-of network benefit, except for emergency care. HMO participants can be members under a group insurance plan or they can be individual or family members. What is a POS Plan? A Point-of-Service (POS) is a hybrid of the HMO and the PPO. Typically, the POS is an HMO with an added out-of-network benefit. In most circumstances, a POS plan has “Open Access”.
