A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
Call our agency partners 866-553-3223
Call our agency partners 866-553-3223
Banner icon

ACA deadline extended: Enroll by Dec. 18 for coverage effective Jan. 1.

Featured Featured
What are the deadlines for the ACA’s open enrollment period?
A list of the open enrollment deadlines for enrollment in 2023 ACA-compliant health insurance in every state. Open enrollment ended on January 15, 2023 in most states.
Latest News & Topics Latest News & Topics
Featured Featured
Applying for ACA Coverage?
Understanding how small differences in projected income can have a large impact on your health plan costs can be key to obtaining affordable coverage.

health maintenance organization (HMO)

What is a health maintenance organization?

healthinsurance.org health insurance glossary

Health maintenance organizations, or HMOs, are a type of health insurance plan. If your coverage is an HMO, you’ll need to pick a primary care physician (or your insurer will pick one for you), and that person will serve as a “gatekeeper,” meaning that you’ll need to see your primary care physician for a referral before you can see a specialist.

This is in contrast to PPOs (preferred provider organizations), which allow members to see any doctor in the network (and in many cases, outside the network too, albeit with higher cost-sharing), without a referral. The trade-off is that HMO coverage is typically less expensive than comparable PPO coverage.

Out-of-network care generally isn’t covered at all under an HMO, unless it’s an emergency situation.

In the individual insurance market, HMOs have become much more common (and PPOs have become less common) since the bulk of the ACA’s regulations took effect in 2014.

sticky-bottom-cta

Get your free quote now through licensed agency partners!