Your primary care physician
An HMO is a health care organization that attempts to lower health care costs for you or your employer. HMO stands for Health Maintenance Organization and it is one of the major health insurance plans along with PPOs (Preferred Provider Organizations) and POS (Point Of Service) plans. The major benefits of an HMO center on cost while the detriments involve a lack of choice in who will treat you.
Cost
A major advantage of being a part of an HMO is cost. The cost of monthly premiums with an HMO is often lower that typical health insurance. Many HMOs also have very low co-payments for services or prescriptions as opposed to the 80 percent coverage that is standard in much health care. Some HMOs also have no deductibles or annual maximums, which can add up over the course of a year in regular health insurance.
Claim Forms
In standard health insurance, claim forms must be filled out for up front medical care, and there may be a waiting period for you to be repaid by your insurance company. Since HMOs do not require that you pay up front more than just the co-pay, there is no wait to be repaid an up front payment.
Primary Care Physician
Having a Primary Care Physician (PCP) can be both an advantage and a disadvantage. In an HMO, you must have a PCP who is part of the HMO's network of doctors who refers you to all other specialty doctors. For those who have never had a constant general practitioner, this is a benefit, as a doctor can get to know a patient longer and develop a good relationship with him. The doctor will also take care of scheduling appointments with specialists when a referral is needed. One of the detriments of having a PCP is that if you have had a doctor you used to see who is not part of the HMO's network, you will have to switch to a new doctor. Also, any delay that occurs with your PCP's referral to a specialist will result in a delay in you seeing that specialist.
Capitation
The concept of capitation means that doctors receive a flat fee each month for every person they cover when they are part of an HMO. This means that visits may be quicker than normal, especially if a doctor has many patients to see. When a patient has a lot of questions for a doctor, this may lead to hurried answers and quickly written prescriptions.
Choose Your Own
When you are part of an HMO, all the doctors that you see must be part of that HMO's doctor network. This includes specialists that your PCP refers you to. Some hospitals will also only use specific HMOs, which means that you will not always have a choice of your hospital.
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