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How to Buy Health Insurance - Definitions & Purchasing

What is an HMO?

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  • What is an HMO?

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  • Transcripts

    Host: What is an HMO?

    Bob Hurley: An HMO is a Health Maintenance Organization. An HMO is basically, a contracted network of doctors in hospitals, in pharmacies. The insurance companies or the Health Maintenance Organizations put together these networks in an effort to, number one, negotiate aggressively with them on price and then the idea would be that once they have negotiated pricing with the doctors and the pharmacies and the hospitals, they would then go out and sell health insurance products or maintenance products to consumers at lower rates than what they could get otherwise because of this well defined discounted, negotiated pricing that they have achieved with some of these providers.

    Often times, you hear the terminology 'Gatekeeper' referred to in HMOs because typically your care is well managed. Health Maintenance Organization means managed care and so they are attempting, they, mean the maintenance organizations are trying to manage your care and so they often set up a number of gatekeepers so that when you access the healthcare system you have to go through various different gates to get to the next level of care. The thinking being that they are going to help you manage not only, getting the care you need but also manage the cost of that care by making sure that you only get procedures that are needed and you only get them from contracted providers whether they be doctor and hospitals or pharmacies and so again, a health maintenance organization typically is going to be very involved in the management of your care and often times, in most of the cases they are referred to as managed care.

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