What is an HMO?

A Health Maintenance Organization (HMO) is a type of health insurance plan that requires members to select a primary care physician (PCP) who coordinates all their healthcare needs. HMOs typically limit coverage to care from doctors and hospitals within their network, except in emergencies, and require referrals from your PCP to see specialists. These plans generally offer lower premiums and out-of-pocket costs in exchange for less flexibility in choosing providers.

Why HMOs matter

• Controls costs: Generally offers lower premiums and predictable copayments
• Emphasizes preventive care: Focuses on keeping members healthy through regular checkups and screenings
• Simplifies healthcare: PCP coordination helps manage all aspects of your medical care

How Solace can help

A Solace advocate can help you navigate HMO rules, select an appropriate primary care physician, and obtain necessary specialist referrals. Advocates can also assist with appeals when services are denied and help coordinate care within network restrictions.

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