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Social Health Maintenance Organization (SHMO)

What is a social health maintenance organization (SHMO)?

A social health maintenance organization (SHMO) is a health plan that provides patients with all of the standard services of a Medicare HMO, such as provider visits and services with other healthcare professionals. In addition to these standard services, SHMO plans also offer other non-standard services, such as personal care and medical transportation, and hearing, vision, and dental benefits.

As with traditional health insurance plans, patients may still be responsible for copays and other coinsurance costs for certain healthcare services while enrolled in an SHMO.

Why are social health maintenance organizations (SHMOs) important in healthcare?

SHMOs fill an important gap in the health insurance market, particularly for aging patients or patients who require frequent medical care. Seniors and other individuals requiring a higher frequency of medical services have the option to pay more in monthly premiums allowing access to a far wider range of medical providers and services. This payment structure enables many individuals to receive the affordable care they need without paying exorbitant uninsured rates for each service they require, preventing medical costs from getting out of hand.