What is an HMO?
Information on Affordable Health Insurance Quotes from Health Insurance Plus
Health Maintenance Organizations (HMOs) were created by insurance providers as a
way to control rising health care costs by managing care, controlling services,
and rewarding clients for using preventative medicine. HMOs limit your physician
choice, require a referral from your primary physician to see a specialist, and
prefer prior approval for emergency room trips. In exchange, you receive lower co-payments,
low premiums, and minimal paperwork.
HMOs At-a-Glance
Manages Healthcare cost by restricting doctor access and focusing on preventative
care.
Positives
- Low Cost at time of service
- Focus on preventitive care
- Low maximum out of pocket
- Low or no deductible
Negatives
- Expensive monthly premiums
- Limited specialist referrals
- Reduced doctor selection
- Capitated reimbusrments to providers
Popular Individual HMO Plans
Originally, HMOs were the less expensive alternative to PPOs, but lately, HMOs have
become more expensive. HMOs are better tailored to group health insurance plans,
as opposed to individual health plans.
How does an HMO Plan work?
HMOs are structured to give you fewer choices and more simplicity. The patient chooses
a Primary Care Physician (PCP) who acts as a gatekeeper. Usually, there is no deductible
or copayment to see the PCP. The patient must obtain a referral from the PCP to
see a specialist. Certain preventative procedures, like well child exams and mammograms,
are covered at no cost. This eliminates later health costs by preventing disease
or catching it early.
Typically, when the patient goes to their PCP, there is no paperwork. However, the
HMO provides no coverage for out-of-network services unless there is no in-network
equivalent and the PCP has already written a referral.
Plan Types
