How Do Health Maintenance Organizations Work?

Health maintenance organizations provide health care services to their members through health care providers that they enter into contracts with. The contract entered with the health providers allow premiums to be lower, as health providers have the advantage of having patients sent to them. The history of HMOs dates back to the early 1900s when companies started providing their employees with plans of prepaid medical services. Health maintenance organizations have become very popular because they cost less when compared to alternative health care policies sold by insurance companies.

How do HMOs work?     

Health maintenance organizations enter into agreements with hospitals, doctors, physicians, and clinics in order to offer health care services within a specific region. For a person or group to belong to an HMO, they should be working or living in the HMOs service area or within its network. A member of an HMO is required to use doctors or physicians assigned to them in the service areas, except in the case of an emergency where special, urgent health care is required. The HMO plan covers the member, their spouse and their kids in case of illness. After registering with an HMO, the contributor is required to select a primary care physician from a list of doctors within the network. The PCP oversees all your medical care and if you require a referral, the PCP is the one who gives you. Choose your primary care physician wisely as all medical care that you require will be obtained through them.

What Contributors of an HMO pays

First, there are premiums; these are monthly payments made by contributors or members of an HMO. Employees who belong to an HMO have their contributions deducted from their basic salary every month. Some employers pay a certain percentage for their members while others don’t pay at all. Secondly, there are co-payments; this is a fixed amount a person pays for a health service under a plan, usually after getting the service. Co-payments vary according to service with emergency or specialized care being more expensive. Lastly, Health maintenance organizations have deductibles; this is the amount you pay out of your own pockets before the health insurance pays anything towards your medical expenses.

Factors to consider when selecting an HMO

Before selecting a health plan, make ensure that you get to understand what the plan covers and whether it is suitable for you or not. With Health maintenance organizations, you receive lower medical costs. Some of the factors to look out for when choosing an HMO include the following:

Know the hospitals that the HMO’s network covers.

Is your preferred doctor in the HMO’s network?

Are the doctors and hospitals located close to you?

How much will you have to pay for the premiums, co-payments and deductibles?

Are other members of the plan satisfied with the services?

Feel free to check out the condition of the facilities you intend choosing…

5 Comments. Leave new

Agboola Afeez
December 6, 2017 9:40 am

If I want to choose plan for my family ,I,my wife and 2 children, like how much am I going to pay per annum, because Diamond send Hmo insurance to me ,but I dont understand.


I can put you through. Let’s chat..


please I need contact of hmo organization my company is interested


Hi Okome, kindly use the quotes form at the sidebar of this page.


You need to know the HEALTH PLAN that you want to apply for because they have different plans with variation of price, but ensure that you understand what the plan covers and whether it is suitable for you or not.


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