What is a health maintenance organization (HMO)?

A health maintenance organization (HMO) is a type of managed care health insurance plan designed to provide a comprehensive range of healthcare services to its members. It operates on a network basis, meaning that members are required to receive their medical care from a specific network of doctors, specialists, and hospitals that have contracted with the HMO. This structure helps control healthcare costs and encourages preventive care, as the HMO typically focuses on maintaining member health through regular check-ups and screenings.

In this model, the primary care physician often acts as the gatekeeper, coordinating patient care and referrals to specialists within the network. This system can lead to better management of patients' overall health and reduce unnecessary services.

Other options describe different types of insurance or programs that do not accurately define an HMO. For example, plans that only cover emergency services do not encompass the full range of care provided by HMOs. Similarly, organizations that exclusively insure high-risk individuals or government programs for the elderly do not align with the HMO model, which aims to cover a broad spectrum of healthcare needs for its enrolled members within a defined network.