What an HMO is
HMO stands for Health Maintenance Organization. An HMO plan builds a network of doctors, hospitals and pharmacies in your area, and your care happens inside that network. Emergencies are covered anywhere, and so is urgent care when you are away from home and dialysis, but routine care outside the network generally is not covered at all.
The rules that come with it
What you get in return
Premiums are often low and frequently zero dollars. Copays are predictable, the plan has a yearly out of pocket maximum, and extras like dental, vision and hearing are often included. For people whose doctors are already in the network and whose care mostly happens near home, an HMO is often a strong fit.
Who an HMO suits
An HMO fits people who want to keep monthly costs down, get their care close to home, and do not mind their care being coordinated through one primary doctor. If you travel for months at a time or insist on seeing any specialist directly, look at a PPO instead.
