Health Insurance

HMO (Health Maintenance Organization)

A health plan with a tight network and required referrals from a primary care physician.

Last reviewed: May 2026 · Editorial methodology

Definition

A type of health insurance plan that requires you to use a network of doctors and hospitals and get referrals from a primary care physician (PCP) before seeing specialists. HMOs typically have lower premiums but less flexibility than PPO plans. Out-of-network care is generally not covered except in emergencies. Kaiser Permanente's integrated model is a high-profile HMO example.

Where this term matters

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Tip

Glossary definitions are educational. Always check your own policy language — insurers can define common terms differently from one another. When in doubt, request a written explanation from your agent.

Related terms

PPO (Preferred Provider Organization)A flexible health plan that lets you see any doctor, with lower costs in-network and no referrals.EPO (Exclusive Provider Organization)An EPO combines the cost savings of an HMO with slightly more flexibility, but locks you into a defined provider network.HDHP (High-Deductible Health Plan)An HDHP trades a lower monthly premium for a higher deductible, making it pairable with a tax-advantaged HSA.

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Source: Cover Forge USA editorial team|Last verified: May 2026|Methodology
Definitions are educational and may be simplified. Always refer to your policy contract and consult a licensed agent for terms that affect coverage decisions.
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Cover Forge USA Editorial Team

Editorial Lead

This article was researched and written by the Cover Forge USA editorial team against federal sources (NAIC, CMS, FEMA, DOL, SSA, state DOIs) and standard policy forms. Bylines organize content by topic — they do not assert individual licensure. See our editorial-policy for details.

Reviewed June 2026

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