HMOs can be a good fit for many patients.
HMOs, or health maintenance organizations, are a type of health-care insurance designed to control future health-care costs by maintaining consumers' present health. When you join an HMO, you receive medical care from the health-care providers that the HMO has contracted with to make up its network. Like other varieties of health insurance, HMOs have advantages and disadvantages and may not be a good fit for all consumers.
Cost
Cost is one of the main advantages of an HMO. HMO members typically pay less for their health care than members of traditional plans. Members are responsible for monthly premiums, copayments and possibly coinsurance and deductibles, all of which are typically less than expenses in traditional insurance.
Paperwork
HMO members also enjoy the advantage of limited paperwork. Instead of filing claim forms after receiving medical care, patients simply present their health insurance card when they receive services and the provider bills the HMO.
Covered Procedures
HMOs usually cover a wide range of services. Since HMOs benefit from keeping their customers healthy, plans typically provide preventative care such as cancer screenings, well-child visits, physicals, immunizations and routine office visits. However, HMOs may not cover certain procedures if they have not been demonstrated to be effective. This can be disadvantageous for patients wishing to try experimental procedures or procedures with lower success rates.
Choice of Providers
Another potential disadvantage of HMOs is that you have limited choice when it comes to selecting your health-care providers. Since HMOs only contract with certain providers, the HMO will only pay for your medical care when you see providers within your HMO's network. If you are flexible about choosing your health-care providers, this limited choice may not be an issue; you can simply choose new providers from the HMO's network when you sign up for your plan. If you already have existing relationships with providers and wish to continue seeing those providers, however, limited provider choice is problematic if these providers are not part of your HMO's network. Even if your providers are currently part of the HMO's network, HMOs and providers can discontinue their contracts at any time so you have no guarantee that your providers will continue to be covered under your plan.
Referrals
HMO members receive most of their medical care through their primary care doctor. If you ever want to see a specialist, you will first need to visit your primary care provider in order to obtain a referral. This setup adds a bit of extra time, delay and hassle for members wishing to see specialists. Referrals may also be difficult to obtain if your primary care doctor is reluctant to provide them.
Limited Service Area
With the exception of emergency coverage, HMOs typically only cover medical care within a certain geographical service area. This restriction may be a disadvantage if you travel frequently, maintain a second place of residence or wish to cover a dependent living in another geographical area.
Tags: medical care, health-care providers, primary care, care doctor, health insurance, limited choice
