HMO: What It Means

With so many different health insurance programs, how do you know which one is right for you? HMO is one that you should become familiar with. HMO stands for Health Maintenance Organization. It’s a network of healthcare providers that have contracts with an insurance company to provide their services at a set price. HMO’s do have many rules that you will have to follow and do tend to be very restrictive. So how does HMO basically work for you and is it for you?

HMO requires that you select a primary care physician who will manage every aspect of your healthcare needs. This primary care physician must be a member of the HMO. The disadvantage of this is you may have to switch primary care physicians until you find one in the network that is near you unless you want to travel. If the physician isn’t in the network of HMO’s then the work will not be covered under your insurance plan. If you need a specialist for anything you must first get a referral from your primary care physician.

HMO’s main advantages over the other programs, is the cost. HMO’s are cheaper for the consumer and premiums are a lot cheaper with an HMO. Co-payments are usually low cost or free, so this is a big selling point to consumers as less out of pocket expenses are something today’s consumers are looking for. HMOs are designed for profit so you can expect your doctor to be very busy, as he has to see many patients since the goal of the HMO is to turn a profit. Doctors tend to want to spend more time with their patients but that’s not always possible as HMO’s need to turn a profit or will be forced to close. Employers pay a portion of the monthly fee that is required to join the HMO. Usually whatever is left is the employee’s responsibility to pay weekly out of their paycheck.

Co-payments are a big issue in most HMO’s for a number of different reasons. The main reason is that a co-payment sometimes deters people from using the service. For example hospital co-pay is a lot more expensive which tends to get the person wait and go to his primary care physician, as the co-pay for your doctor is a lot less. This seems to work well in the HMO scheme of things. Co-pays are also used to offset the overall cost of the insurance and makes everyone pay their fair share which forces the people who use it the most to pay the most into the plan.

So is a HMO best for you? Or would regular health insurance be the way you should go? These questions have many various answers, depending on a lot of factors. If you have a family buying your own group insurance for your family can get quite expensive. HMO’s were designed for controlling expenses and managing all aspects of your healthcare in one place. This seems to work well with a family. Now as an individual this may or may not be for you. If you personally have a favorite doctor or hospital and it’s not on the list of HMO providers than you probably would better off not going with the HMO system as it won’t cover doctors or hospitals not listed as a approved provider.

People for the past few years have watch healthcare costs skyrocket with no end in sight it seems. HMOs try to help control costs, which are one of the reasons HMO’s keep growing and getting more popular each and every day. The only real disadvantages with HMO’s are that they can be restrictive and might not let you do what a normal health insurance company will. The main reasons is with all the members they have to insured they do need an across the board rules that everyone can follow to make it fair to all the people they insure. HMO’s aren’t for everyone so if you are going to join an HMO does plenty of research before you join so you know what you will be receiving and what you won’t be getting. That way you can make an informed decision on your healthcare needs.