What is a HMO heatlh insurance plan?The definition of a Health Maintenance Organization or HMO is a corporation financed by insurance premiums whose member physicians and professional staff provide curative and preventive medicine within certain financial, geographic, and professional limits to enrolled volunteer members and their families. HMO's is an organization of healthcare providers that have contracted with an insurance company to offer their services at a fixed prices. HMO plans tend to be very restrictive and have many rules. You will be required to select a primary care physician, who manages all aspects of your healthcare. The primary care physician(PCP) must be a member of the HMO, so you may need to switch doctors if the one you are currently seeing is not in the network. If you need to see a specialist, you will be required to see your primary care physician first to obtain a referral.
Are HMO less costly than PPO health insurance plans?The major advantage to HMO's is the cost. Monthly premiums are typically lower than those for other types of plans and co-payments are very low, or even free. However, keep in mind that HMO's are for-profit businesses. They have to make money somehow, and often this means that doctors must see as many patients as possible each day and minimize costs for the organization. HMO's are designed to save people money while getting the entire healthcare they need. Co-pays for visits and prescriptions are usually very low and there is no or low deductible to be met. However, HMO's do have their downside. HMOs are in business to make money and if you have many health care issues, you may not be accepted or have to pay more - a lot more. Having chronic medical condition that requires many visits, tests, and treatment costs the HMO lots of money and they balance this out by keeping a tight hold on your health care. They must approve all visits prior to you going.
What kind of provider flexibility do HMO's offer?HMO’s or Health Maintenance Organizations offer less flexibility when choosing a provider. With an HMO you are required to choose a primary care physician(PCP) who will take are of most of your healthcare needs, when you want to see a specialist you will need to be referred by your PCP.
Do HMO's health insurance plans have deductibles?One of the main differences in HMO is not having deductibles or having a very low one. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP.
What are my out-of-pocket expenses with a HMO plan?Typically, HMO’s have lower out of pocket expenses then PPO insurance health plans. The HMO plans that JC Lewis Insurance Services recommends range from $3000-$4000 for a single member. The PPO out of pocket plans can range anywhere from $1500-$7500 for a single member. Although many firms throughout the state of California claim HMO’s to be a cheaper option, they most likely are more expensive on the average.
Are HMO's health insurance plans restrictive?HMOs are usually extremely restrictive and have lots of rules that must be followed if you want them to pay. You can only see the doctors on your HMO list, and you must see your primary care doctor first, no matter what is wrong with you. If you have to go to the hospital you must have your primary doctor’s permission prior to going. Many people find that way too restricting and choose to not go with HMO's for that very reason. When and if you need to see specialist, you must have seen your doctor first to make sure they can’t treat you instead of going to a more expensive doctor. The HMO makes sure it is their doctor who has control over all your medical needs, not you. Most doctors are excellent and will hand out referrals and most doctors these days are enrolled in HMO plans so this isn’t a problem for many people. If you are not one of the lucky ones, getting the care you need could be difficult or non-existent. HMO's can also be a bit fussy about you wanting to change your primary doctor. So be sure that you like your doctor and you have spoken to other people who are patients of him or her
Do HMO doctors have patient quotas?Most HMO's also have a patient quota that the doctor has to comply with. He or she must see a set number of patients per day to avoid penalization or being removed from the group. This is why there is never enough time to talk with your doctor past your examination point. They need to keep it short so they can see more patients. There is also the concept of Capitation that gives contracted doctors a set amount of money for each patient each month. This is given no matter if the patient is sick or well. Lastly you must make sure any labs or tests you need are covered with your plan or they won’t be covered. But for most people who have HMO's this is not a problem and their doctors are great, so they don’t have any problems at all.