What is an HMO?

HMO ratesHealth Maintenance Organization (HMO)

What is an HMO? HMO's are both insurers and health care providers. They accept responsibility for a specific set of health care benefits offered to customers and provide those benefits through a network of physicians and hospitals.

Many people today are using HMO's. According to a New York Times article (Freudenheim, M. "Health Care in the Era of Capitalism," New York Times, April 2, 1996), an estimated 58 million Americans are enrolled in HMO's, and another 81 million are enrolled in other types of managed care. A July 8, 1996 Reuter's article says that more than 4 million Medicare beneficiaries and 12 million Medicaid recipients are in HMO's and other managed-care plans.

What kinds of HMO's are there? Staff model HMO's own and operate physician-staffed health centers that offer a broad range of medical care including laboratory, x-ray, vision, and pharmacy services.

Group practice HMO's contract with medical groups to provide health services to HMO members.

Independent Practice Associations (IPAs) are HMOs that contract with individual physicians.

Questions?

NJ HMO Questions and Advice