Health Maintenance Organization (HMO)



Health maintenance organization (HMO) plans offer comprehensive health insurance, which cover a basic array of benefits for a monthly premium, in addition to copayments for prescriptions and visits to a physician. The copay is required at the time the service is received, and is usually a predictable number determined by your plan. It is encouraged to see in-network providers when you have an HMO, because they usually do not cover any out-of-network services.

HMOs provide managed health care, which means that your medical providers are selected for you through an organized network. Managed care is designed to keep down the cost of health care and be an efficient, affordable way to receive quality medical services. HMOs work by paying in-network physicians a monthly rate and offering other bonuses. Because of this, the doctors can charge less for an HMO plan than their typical costs. An in-network copay is usually in the range of $10 to $40 for office visits.

How do you know if an HMO is the perfect plan for your needs? Some reasons to choose an HMO are:

  • Some HMOs can have a larger network than other types of plans
  • No need to file claims to cover in-network doctor or hospital services
  • High emphasis on preventive care coverage (saving money in the long run, as less serious illnesses are less serious to pay for)
  • Affordable fixed rates for copays
  • Simplified process of receiving care with pre-selected doctors, facilities, and specialists

Other considerations you may want to make before you decide on an HMO are if you have a specific primary care physician you want to stay with, and if they operate on an HMO. Also, if you prefer to choose your own specialists, rather than having a narrow choice of in-network providers, an HMO may not be for you (read about PPO plans). If your doctor is exclusive to one network they will not necessarily be on an HMO. Some physicians belong to an individual practice association (IPA), which contract with several HMO insurance plans. You also should consider the radius of coverage under the HMO plan, and if it is located near you. Also, making sure the primary care provider you select is someone you trust, because they will be arranging all of your health care.

 

 Sources:

1. VitalOne Health, “HMO Health Plans”. http://www.vitalonehealth.com/health-plans/hmo

2. Wikipedia.org, “Health maintenance organization”. http://en.wikipedia.org/wiki/Health_maintenance_organization#cite_note-0

3. Wikipedia.org, “Managed care”. http://en.wikipedia.org/wiki/Managed_care