What Is HMO Insurance?

HMO or Health Maintenance Organization is a type of health insurance plan that is different from the convention health insurance policies. The price is lower, but in some cases the number of medical treatments that are covered are limited.

HMO insurance

HMO insurance: The lower the premium the more restrictions in respect to treatment coverage. Like PPO, there is an annual deductible amount and co-pays ranges from $5 to $25 depending on your annual deductible and plan type. In addition you are restricted to selecting a health care provider or physician within the network.

How Do You Receive Medical Care With Your HMO Insurance?

Only in rare and emergency cases you can receive benefits if youneed to get treatment outside of the plan network. Moreover, you may need to get referral from your physician within the network before you can visit a specialist for your treatments. While in PPO or Preferred Provider Organization has similarities to HMO but policies are less restrictive. The amount you pay depends on your annual deductible and that too, determines the amount and type of medical treatments that are covered. Co-pays range from $5 to $40 per visit.

How to Find Affordable HMO (Health Maintenance Organization Insurance) Plans.

Many insurance companies offer their prospective and current customers the option to select and discover the best insurance policy for them via the company website portal.

Both PPO and HMO health insurance plans give you opportunity to search at your discretion reasonable priced health insurance.

See Also: EPO Insurance

You can also visit one stop shop websites which will, at no cost to you, provide quotes from many difference insurance companies. You then select the best one according to your family medical needs and budget.

History of Health Maintenance Organization Insurance (HMO)

Health Maintenance Organization Insurance medical insurance plans offer the most affordable health insurance option for literally millions of Americans today.

When HMO medical insurance plans were introduced a few years ago they were anything but popular and led to a flood of complaints from some very unhappy plan holders. However, the insurance companies listened carefully to those complaints and today HMO plans are the preferred option for many people across the country.

The biggest complaint was the restriction placed on plan holders when it came to seeking treatment from healthcare networks which simply were not adequate. Now however, while there are still some restrictions placed on plans, these are far less of a problem than they used to be and are more than compensated for by the lower costs which HMO plans bring.

Even if you are feel that you need a little more freedom of choice however all is not lost as variations of the original HMO plan, such as PPO and POS plans, are now widely available and can offer great cover at a price which will not break the bank.

If you would like to find out more about HMO medical insurance plans which will suit your personal needs, and those of your family, then simply follow the article.

What Does HMO Insurance Mean?

As we have discussed earlier Health Maintenance Organization Insurance plans are policy issued based on a network of health professional, physicians, health care centers, hospitals and specialist who take part in administering your health care needs. There are, however, private or independent HMOs where the entire medical specialist involved work directly for that private HMO insurer.

Within a network a host of doctors and health professionals can agree to designate fees for services rendered under the auspices of different HMO plans that are issued by HMO issuer. HMOs are issued with the intention to save on healthcare cost while having access to a whole blanket of healthcare coverage. Co-pays for doctor visits and prescription drugs are normally low and there is no deductible to cover, a contrast from PPOs.

Benefits and Disadvantages of HMO Health Insurance

Health maintenance Organization plans (HMO) and Preferred Provider plans (PPO) both have their benefits and disadvantages.  Actually it depends on what are your needs and what are you choosing? So a smart and wise selection makes all the difference.

There are many insurance holders who have a preference for one or the other. Both insurance types have similar benefits but the disadvantages, drawbacks or pitfalls depending on what you are looking for in an insurance policy.

HMO is an excellent choice in many situations. There are, however, disadvantages, drawbacks and pitfalls to HMOs. The whole insurance industry is in the market for making money and if you have unusual amount of health care requirements you may be forced to pay more for your plan. For patients who need frequent doctor visits, medical checkups and treatments they will have to pay more for HMO plans. As demand for medical treatment goes up, so does price.

To control cost within the network, HMOs require you to call prior to doctor visits and treatment. HMOs apply much more restriction than PPOs and you have to follow the guidelines written in your insurance policy in order for them to pay for your health bills. In addition, you can only visit physicians within your network. In cases of emergency or special medical needs, you will have to see your primary care doctor first.

For instance, if you are sick and need to go to the hospital you will have to call your primary care doctor first, who makes most of the decision about your health care needs.  Due to such restrictions many insurance holders leave HMO for PPO.

There can be restrictions in changing from one primary care doctor to another. Therefore it is vital to first select a doctor you really trust and like. This might be one of the most important health decisions you will make. Do a little research. Ask other patients who visit the doctor.

While searching for “what is an HMO insurance”also search online for feedback and comments on the doctor. Be aware that many HMOs have policies that recommends a patient quota to each doctor. This means that your doctor can see only a certain number of patients daily to avoid penalty or removal from the network.

Due to this limitation, the amount of time doctors who subscribe to HMOs have with each patient is stationary and that could reduce the one-on-one time he / she spends with you. Furthermore, the policy of capitation which stipulates that doctors receive a set amount of money for each patient limits personal care. Finally, ensure that all laboratory testing are covered by your HMO plan.

Should you Choose HMO health insurance?

Choosing HMO as your basic insurance health plan depends only on your needs. Which one you select depends a great deal on your medical requirements, lifestyle and budget. HMOs are perfect for people who have a low budget but really need insurance.However, People who desire a greater amount of flexibility in choosing their doctors and medical specialist should opt for a PPO plan..Patients should weight their medical needs, lifestyle and budget to determine which insurance plan to choose. I hope this guide not only answers your main question “what is an HMO insurance”, but also gives you complete insight on the topic.