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Health Maintenance Organizations (HMOs)

By far the most common type, HMOs ostensibly focus on wellness (e.g., by providing for annual physical examinations). Members (who are insured) pay a fixed annual premium in return for health care access that is limited to the HMO’s network of physicians and hospitals. Medical care is also limited to a prearranged, comprehensive list of medical services that will be provided to the enrolled group as a whole. Most HMOs require patients to choose (from the HMO network) a physician as a primary care provider (PCP) who must first be consulted for any medical concern. The PCP, and not the patient, then decides if the patient should consult a specialist or get a second opinion. This practice (common to most forms of MCOs in general) is known as “gatekeeping.”

Inside Health Maintenance Organizations (HMOs)