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What does the HMO provide?

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally wont cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

What are the costs and benefits of an HMO?

Lower cost HMOs are an affordable option for people who dont usually need anything more than basic medical care like annual checkups or immunizations. However, even though costs are generally lower with an HMO, they dont cover any out-of-network care, except in a true emergency.

How does an HMO make money?

HMOs keep their costs down by making agreements with in-network providers to charge a certain amount. The HMO may pay in-network providers on a per-member basis. Its usually a fixed amount every month for each patient, so it doesnt cost them for each visit.

How does an HMO receive payment?

An HMO (Health Maintenance Organization) typically receives payment through a capitation payment model. In this model, the HMO receives a fixed monthly or annual payment per enrolled member from the insurance company or employer. This payment is based on the number of members assigned to the HMO.