Is the HMO Health Insurance Plan for You?

Find out important facts about HMO health insurance plans before making the decision to sign up.

HMO in the medical insurance industry stands for Health Maintenance Organization. HMO health insurance plans guarantee wider coverage in terms of preventive healthcare programs. All HMO members are obliged to select their primary care physicians. You must get a referral from the PCP prior to visiting a medical specialist.

Distinct Features of HMO Plans

HMO health insurance plans have unique features. This type of policy assures plan holders of minimal co-payments along with out-of-pocket costs. Deductibles may not be enforced prior to the start of coverage. Likewise, claimants are not compelled to submit claims to insurers. On the other hand, you are not covered if the service is provided by an out-of-network provider or the appropriate referral was not given by the primary care doctor. Go for an HMO if your requirements are any of those listed below:

  • You want a policy with low premium cost.
  • You prefer a plan with no deductibles even if there is a limit on out-of-pocket expense.
  • If your priority is to have preventive care services, obtain coverage for check-ups and different kinds of immunization.

The plan holder pays a premium every month and in turn, he is provided with healthcare coverage under a group of network services.

Is the HMO Health Insurance Plan for You

What are the Advantages & Disadvantages?

HMO health insurance plans give special benefits to its members such as the regulation of healthcare cost. HMOs make sure that providers will not take advantage of unsuspecting clients by charging excessive fees. This program has very competitive pricing structure although it provides the smallest amount of flexibility. Besides, plan holders are limited to a particular network of medical service providers. Hence, you incur additional expenses if you decide to seek doctors from other networks. Majority of HMOs also ask members to make co-payments for every visit to the physician. Those with chronic conditions are forced to make a number of co-payments that add up to the total cost.

What Should Consumers Know?

Two years ago, HMO health insurance plans and Preferred Provider Organization (PPO) plans were the most favored policies offered by insurance firms. With PPO, the coverage covers both inside and outside the network of a plan provider. Yet, the costs are higher when it comes to out-of-network services. Based on more than 30 states where the government operates the web-based insurance marketplace, both plans had 40 percent each in terms of sales compared to 12 and seven percent of the two other primary plans.

Making the Right Decision

As responsible consumers, you need to find out about the specific provision regarding out-of-network coverage. Is it credited to the maximum out-of-pocket expenditures of members? Certain plans include this although it is not a legal requirement. The next step is to determine if your physician is in that network. This may be or may not be possible. Nonetheless, it pays to be familiar with all these concerns prior to choosing an HMO plan or any other policy for that matter.

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