Health Maintenance Organization — HMO Plans, Coverage, & Quotes
A health maintenance organization, better known as an HMO plan, is right for those who are seeking comprehensive health insurance. What is an HMO, and how does it work?
HMO health plans cover the cost of most health care expenses. You pay a monthly premium, in addition to co-payments for doctor visits and prescription medications. HMO insurance plans require that these amounts are paid when you receive services. With HMO health insurance plans, your premiums won’t go up if you use more medical care.
The first step you must take after buying a HMO insurance plan is selecting a primary care physician (PCP). This doctor must be a member of your HMO plan network. If you need to see a medical specialist for non-emergency reasons, the HMO health insurance plan won’t cover that expense unless you first receive a referral from your primary care doctor. Any specialists you visit must also be in-network. Before selecting an HMO plan, it is a good idea to check out the provider networks of several HMO health insurance companies. A smaller network may reduce your options; for example, some specialties may have few or no doctors present.
Deductibles are either small or nonexistent on most HMO plans. However, fewer deductible-free plans are being offered nowadays. The highest costs come when and if you visit an out-of-network provider. In the vast majority of cases, you will be solely responsible for the entire cost of non-emergency medical care given outside of individual HMO plans’ networks.
An HMO plan heavily subsidizes health care costs by paying doctors in their networks fixed monthly fees and offering other incentives. Therefore, they often charge HMO health insurance plans less than their going rate. The out-of-pocket cost for visiting an in-network primary care physician in-network is a co-pay ranging from about $10 to $40. On the other hand, physicians outside of that network have no such motivation to absorb their costs costs. The full rate for going outside of the network could be several hundred dollars, none of which HMOs will cover.
HMO health insurance plans are significantly focused on preventative care. Many experts believe that such a focus could result in long-term health benefits and cost reductions. Screenings and initial treatments are covered by the average HMO plan, allowing many patients to take advantage of health care sooner. Patients with HMO health plans are more likely to catch diseases, such as cancer, in their earliest stages. When illnesses are less serious, treatments are less expensive and more effective. This can can lead to better health outcomes, as well as lower health insurance costs.
HMO plans also offer greater convenience, because no filing of claims is necessary for your HMO health insurance plan to cover hospital stays or doctor visits within its network.
When may a HMO health plan be right for you? It is most important that you are satisfied with its network coverage. The provider networks of some HMO insurance plans are larger than others. If you have a current primary care physician or any current specialists, check to see if they are in-network before buying an HMO plan. Whether or not your doctor is included depends on if the physician is exclusive to one network, or a member of an individual practice association (IPA)–these groups contract with multiple HMO insurance plans. In addition, there are specific in-network hospitals, labs, and express care/urgent care clinics you must use in order for those services to be covered.
If you need to select a primary care physician for the first time, or select an HMO health plan that doesn’t include your existing one, keep these questions in mind: Are there many doctors and specialists in your area that work with the HMO, preferably within 30 miles of your home or office? What is the average waiting time for a routine appointment in that doctor’s office?. Most importantly, are you comfortable with him or her? A level of comfort and understanding with your PCP is essential in HMO health plans, because he or she will have considerable control over your health care.
Do you have more questions regarding what an HMO is, or if such a plan fits your needs? VitalOne Health and our licensed health insurance agents will help you choose a policy and provide you with HMO quotes from multiple companies.