Health Maintenance Organization (HMO)

  • prepaid health plan which provides comprehensive medical care including  preventive
  • care visits, surgeries, lab work, X-rays, hospital stays, etc.  
  • choices of doctors and hospitals designated by the HMO
  • small co-payments
  • patient needs a referral from their primary care doctor to see a specialist

Questions to ask about an HMO

  • Are there many doctors to choose from?
  • Do you select from a list of contract physicians or from the available staff of a group practice?
  • Which doctors are accepting new patients?
  • How hard is it to change doctors?
  • How are referrals to specialists handled?
  • Is it easy to get appointments?
  • How far in advance must routine visits be scheduled?
  • What arrangements does the HMO have for handling emergency care?
  • Does the HMO offer the services I want?
  • What preventive services are provided?
  • Are there limits on medical tests, surgery, mental health care, home care, or other support offered?
  • What if you need a special service not provided by the HMO?
  • What is the service area of the HMO?
  • Where are the facilities located in the community that serves HMO members?
  • What happens if the patient is out of town and needs treatment?
  • What is the cost of the HMO plan?  What is the yearly total for monthly fees?
  • Are there co-payments for office visits, emergency care, prescribed drugs, or other services?  How much?