Affordable Care Act

Health Maintenance Organization (HMO) Plans

Updated on November 15, 2019


Watch our Video on Health Maintenance Organization Plans:

Get a deeper look into HMOs and how they operate with our brief, informative video.

Health Maintenance  Organization (HMO) Plans

HMO stands for “health maintenance organization.” HMO plans offer a wide range of health-care services through a specific network of provider physicians and hospitals. These providers contract exclusively with the HMO or agree to provide services to the HMO members at a pre-negotiated rate.

As a member of an HMO, you need to choose a primary care physician who will provide most of your health care and can refer you to an HMO specialist when needed. Before enrolling in an HMO health plan, you may want to see if your favorite doctor is in the plan’s HMO network.

In exchange for getting your care through a limited network and seeing a specialist only if your primary care physician refers you, you may save money on premiums, deductibles, copayments, and coinsurance.
Some HMO plans require you to fulfill a deductible before any medical services are covered. Others only require you to make a copayment when services are rendered. Health care services obtained outside of the HMO are typically not covered, though there may be exceptions in the case of an emergency.

Health Maintenance  Organization (HMOs) are a common option

HMO plans made up 53% of all the individual and family plans purchased by eHealth customers, as reported in our Health Insurance Price Index Report.

If you think an HMO may be right for you, eHealth can help you choose from a broad variety of HMO plans. Or, we can give you more information to find the best health plan for your needs and budget. Simply enter your zip code where requested on this page to see a quote today.

Related articles

Join Our Newsletter

Get healthcare news, wellness tips, and coverage resources