HMOs, or Health Maintenance Organizations, are entities that provide insurance for a large group of people. Employer groups are the most common group and most people who have HMO health insurance obtained it from their employer. HMOs usually offer the most commonly used and most well known of the managed care plans that are available in the US.
HMO plans, like many other forms of health insurance, are prepaid. Policy holders pay a monthly fee, which covers all their medical expenses. However this is with the provision that the user’s visits for health care are made to health care providers and specialists that are part of the HMO’s preferred providers (or network) list. The HMO insurance does not pay for visits to non-network providers.
Most HMO plans require users to choose a primary care doctor from the network’s list of doctors. The primary care doctor is basically equivalent to a family doctor. You have the ability to see your primary doctor whenever you need to at no charge. If you are in need of a specialist, you will need a referral from your primary care doctor to a specialist that is part of your HMO network.
It is important that you understand that the costs of any visits to a doctor or specialist that does not participate in your HMO network will not be covered by your HMO insurance. In addition, if you see a specialist without getting a referral first from your primary doctor, then your specialist visits will probably not be covered by your HMO insurance either.
Typically, HMO plans cover either all or some of the following. Not all HMO plans include prescription and emergency services.
- Primary care doctor visits
- Specialist visits, provided your primary care doctor gives you a referral ahead of time.
- Diagnostic laboratory services that have been referred by your primary care doctor
- Prescriptions
- Hospital service
- Emergency services (some HMO plans will cover network and non-network providers for emergency services)
Most HMO plans do not cover what are considered alternative treatments like acupuncture, homeopathy and aromatherapy. Routine dental work and elective cosmetic surgery are generally not covered either. However, coverage varies with HMO plans, so it is important that you understand what your HMO plan covers and what it does not.
HMOs generally only offer insurance to employer groups and not to families and individuals. The biggest advantage of HMO plans is their low cost. HMO plans are usually the least expensive form of health insurance available. This is due to the fact that HMOs deal with a large volume of health care professionals and customers.
An HMO insurance plan may be a viable option for a family or individual who doesn’t have a lot of specialized medical needs. If someone in your family needs to visit non-network specialists on a frequent basis, then an HMO plan would not be a good type of health insurance for your family to obtain.
