A Health Maintenance Organization is a type of health insurance plan that emphasizes preventive and coordinated treatment provided by a primary care physician (PCP). So, because PCP coordinates members’ treatment with in-network specialists, all experts must be referred by the PCP. But in an emergency, out-of-network treatment isn’t typically covered in this.
A Health Maintenance Organization (HMO) is a type of health insurance plan that emphasizes prevention and integrates treatment by requiring a recommendation from an in-network primary care physician in order to see an in-network specialist.
An HMO’s goal is to focus on the well-being of the patient and healthcare while keeping the overall amount down for its members by only paying in-network doctors and institutions.
An HMO has the benefit of having cheaper monthly premiums and out-of-pocket payments than other forms of insurance. HMOs are particularly cost-effective for persons who simply require routine medical care such as yearly exams and vaccines. There are no basic restrictions on the number of primary care visits that can be made.
Whether a PPO or an HMO is preferable relies on a number of considerations, including the members’ overall health, the desired level of choice in selecting doctors and healthcare facilities, and economic limits. It can come to personal choices as well.