health maintenance organization
Noun: A health maintenance organization (HMO) is a type of managed care health insurance plan. It provides comprehensive healthcare services to its members through a network of specific hospitals, clinics, and doctors (providers) that have agreed to offer services at a reduced cost. Members typically choose a primary care physician (PCP) within the network who coordinates all their care and provides referrals to see specialists.
An HMO is a specific model for organizing and financing healthcare. It emphasizes preventive care and managing costs by using a restricted network of providers. - The term is used as a countable noun. - It is often abbreviated as HMO. - It is commonly discussed in contexts of insurance, employment benefits, and healthcare policy.
- "My new job offers insurance through a health maintenance organization, so I had to select a primary care doctor from their list."
- "One advantage of a health maintenance organization is lower out-of-pocket costs for routine visits."
- "She had to get a referral from her HMO doctor before she could see a dermatologist."
- HMO Model: Refers to the specific structure and rules of an HMO plan, often contrasted with other models like PPOs (Preferred Provider Organizations).
- Example: "The classic HMO model requires members to stay within the network for all non-emergency care."
- HMO Plan: A specific insurance product offered by an HMO.
- Example: "We are deciding between an HMO plan and a PPO plan during open enrollment."
- HMO (noun): The standard abbreviation for "health maintenance organization."
- Example: "Is your insurance an HMO or a PPO?"
- Managed Care (noun): A broader term for healthcare systems that manage cost, quality, and access, of which HMOs are one type.
- Example: "The rise of managed care changed how many Americans receive medical services."
- Managed Care Organization (MCO): A more general synonym, though not all MCOs are structured exactly as HMOs.
- Prepaid Health Plan: A descriptive synonym highlighting that members/employers pay a fixed premium in advance for access to services.
- In-Network Provider: A doctor, hospital, or clinic that has a contract with the HMO to provide services to its members.
- Example: "Visits to in-network providers are fully covered by my HMO."
- Primary Care Physician (PCP) / Gatekeeper: The doctor in an HMO who manages a patient's general care and referrals.
- Example: "In most HMOs, your primary care physician must authorize any visit to a specialist."
- Referral: Official permission or direction from a PCP to see a specialist within the network.
- Example: "Without a referral, the HMO will not pay for the specialist appointment."
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group insurance that entitles members to services of participating hospitals and clinics and physicians
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