What is a health maintenance organization (HMO)?

An HMO is a type of health plan that requires you to select a family doctor, often called a primary care physician or PCP. If you are in an HMO, you have access only to those providers within the specific HMO you are contracted with. You need a referral from your PCP to see a specialist in the HMO network, such as a cardiologist (heart doctor) or other professional. Typically, only emergency services are covered if you go outside the health plan network. 
  • To see if your provider is in your HMO network, you can check online to explore who is included in your HMO then verify by calling the provider’s office. Give them your policy id number listed on your card and have them verify whether they are a participating provider for your specific plan. 
NOTE: Regardless of the plan you have, it’s good practice to double check with the provider’s office directly by giving them your policy id number listed on your card to verify how their services might covered under your plan.

Watch the video below to learn more.