HMO

Health Maintenance Organizations, more commonly known as "HMOs, " first attained popularity in California, Oregon and selected metropolitan areas in the United States in the 1970's. Rising health care costs in the 1980's and early 1990's gave impetus to federal support of HMO's as alternatives to traditional fee for service and preferred provider health insurance plans. Although there are different types of HMO programs, enrolled participants pay a fixed monthly fee for medical services provided with health professionals and facilities under contract to the health plan provider. Persons enrolled in HMO plans usually pay a lower premium and have less out-of-pocket costs than persons enrolled in other health plans in exchange for giving up their choice of a health care professional and facility.

Health care in America is changing rapidly. Twenty-five years ago, most people in the United States had indemnity insurance coverage. A person with indemnity insurance could go to any doctor, hospital, or other provider (which would bill for each service given), and the insurance and the patient would each pay part of the bill.

Insurance in todays World

Today, more than half of all Americans who have health insurance are enrolled in some kind of managed care plan, an organized way of both providing services and paying for them. Different types of managed care plans work differently and include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point-of-service (POS) plans. HMOs are the most common type of managed Health care. Currently, there is much concern regarding the injuries and deaths of HMO members caused by delayed care or denials. Also of concern is their right to sue for damages.

What is managed care?

Managed care refers to health plans coordinating your health care with you and the providers that participate in the health plan.

What is a HMO?

HMO is the abreviation used for - Health Maintenance Organization. Typically HMOs provide members with comprehensive health care. When someone joins an HMO, they become a member and select a primary care physician from the list provided by the HMO. That primary care physician coordinates all of that member's medical care. If care by a specialist is needed, the primary care physician will refer the member to a specialist who is usually also in the HMO network. In an HMO, physicians may be employees of the HMO or the HMO may contract with independent physicians to provide care. Members who go outside of the network to receive care (unless given prior approval) will probably pay all or most of the cost of that care out of their own pockets.

What is a Medicare HMO?

A Medicare HMO is a contract with the federal government under the Medicare+ Choice program to provide health benefits to those eligible for Medicare that choose to enroll in the HMO, instead of receiving their benefits and care through the traditional fee for service Medicare program.