HMO.
In plain English
An HMO (Health Maintenance Organization) is a type of health insurance plan that pays for your care only when you use doctors and hospitals inside its network. You usually choose a primary care physician (your main doctor), and that doctor refers you to specialists when you need them. Premiums and out-of-pocket costs tend to be lower than other plan types, but the tradeoff is less freedom to see whoever you want. Outside emergencies, the plan generally pays nothing for out-of-network care, so you would owe the full bill.
01Why it matters
An HMO can save you real money each month, but if you see an out-of-network doctor by mistake, you can be stuck paying the entire bill yourself.
02The math, step by step
You join an HMO and pick Dr. Lee as your primary doctor. Your knee hurts, so you see Dr. Lee, who refers you to an in-network orthopedist. The plan covers the visit after your copay. If you had skipped the referral and gone straight to an out-of-network specialist, the plan would likely pay nothing and you would owe the full charge.
03What this is NOT
An HMO is not a PPO. A PPO lets you see out-of-network providers (at higher cost) and usually does not require referrals. An HMO locks you to the network and usually requires referrals through a primary doctor.
04Receipts
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Plain-English answers from our glossary. Receipts included. Never advice.
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