Glossary · Plan types
What is a health maintenance organization (HMO)?
An HMO is a health plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally does not cover out-of-network care except in an emergency, and it may require you to live or work in its service area.
Definition and figures from HealthCare.gov glossary, checked October 23, 2026. This page explains the term; it does not recommend a plan.
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HMO: the facts
| Item | Fact | Source |
|---|---|---|
| Out-of-network care | Generally not covered except in an emergency | HealthCare.gov glossary: Health Maintenance Organization (HMO) |
| Service area | May require you to live or work in it | HealthCare.gov glossary: Health Maintenance Organization (HMO) |
| Referrals | Many HMOs require a referral from your primary care doctor before you see anyone else | HealthCare.gov glossary: Referral |
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Questions
What does HMO mean in health insurance?
An HMO is a health plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally does not cover out-of-network care except in an emergency, and it may require you to live or work in its service area.
Does an HMO cover out-of-network care?
HealthCare.gov says an HMO generally won't cover out-of-network care except in an emergency.