HMO Health Insurance

By Compuquotes Team on October 16th, 2009
Health Insurance

HMO Health Care: The Good, The Bad, The Managed

HMO health insurance plans can save members on costs for medical services, but they have plenty of restrictions on physicians and providers.

All About Health Maintenance Organization (HMO) Insurance

Managed care health insurance is typically offered to employees and members of their families as one of several group insurance options. The provider offering the insurance teams up with hospitals, clinics, laboratories, and physicians to form a network that offers discounted medical insurance plans to members.

The HMO evaluates the levels of service offered by member physicians and health care providers to determine limits on service coverage for visits and procedures. When you enroll in an HMO health insurance plan, you may find that a total number of visits or total cash payment for services has an annual ceiling. And HMO health insurance members must visit practitioners who are part of their network.

Restrictions of HMOs over Individual Health Insurance

Unlike traditional individual medical insurance participants, members of HMOs may find their abilities to choose providers limited by the insurance plan. For example, you may be asked to name a primary care physician under terms of the HMO group insurance. You have to decide from a list of specialists and pick your physician. For example if you have children, you may need to choose a primary physician with a specialization in pediatric medicine.

If you decide to see another doctor or specialist, you'll need a referral from your primary doctor before you can go. If a physician or specialist recommends a service or procedure out of the customary course in your plan, you may need to wait for a time-consuming case review. Under an individual insurance plan, you may choose a physician in the network at any time, rather than identify a primary care doctor.

Overall Cost Savings with HMOs

On the plus side, when you enroll in an HMO health plan you may enjoy lower co-payments or total deductibles. HMO providers often decrease the total costs of medical care by controlling unnecessary costs.

You may end up paying less for prescriptions, vaccinations, vision, and dental care if those components are included in your HMO plan. An HMO plan also covers visits to diagnostic laboratories in the network, emergency services, prescriptions, and referred visits to specialists.
However, managed care health plans habitually place caps on the numbers of visits you may make for annual checkups, chiropractic services, or mental health counseling. If you are forced to visit an out-of-network physician or a clinic outside your coverage area, you may have to pay the full price for services. With an HMO, you take the good along with the bad.

Strength in Numbers

With an individual traditional health insurance plan, you may visit your primary doctor, who then makes appointments with laboratories, specialists, and other services. Care is not as easily coordinated as it would be beneath the umbrella of an HMO program or participating facility.

In short, with an HMO, communications and coordinated care between members and practitioners can be instantaneous, speeding up care and medical intelligence between professionals. Your care has a central coordinator in your primary care physician.

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