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HMO Health Insurance: Advantages, Disadvantages, and Options

The major advantage of an HMO Health Insurance plan is that your medical costs are tightly controlled.





HMO Health Insurance

by Steve Theunissen

What is it?

A Health Maintenance Organization (HMO) is a company to whom you pay a fixed monthly fee in return for a range of medical benefits. The organization consists of a network of physicians. From this network, patients can then select a primary care physician. In emergency situations some HMO Health Insurance plans allow patients to select from a wider pool of physicians.

Most HMO Health Insurance Plans require that you make a part payment at the completion of each visit to your medical professional. This generally ranges from between five and ten dollars per visit. A prescription surcharge of around five dollars also applies. Some HMO Health Insurance plans, however, do not charge anything for visits and prescriptions.

What are the drawbacks?

The popularity of HMO Health Insurance plans may well be due to the fact that there are no laborious claim forms to complete after each visit – you simply present a card. There are, however, certain drawbacks to choosing HMO Health Insurance:

(1) Because the plan is limited to a select network of medical professionals you will probably be waiting longer for an appointment than you would if you were covered under an indemnity health insurance plan.
(2) You do pay a fixed fee per visit so it is in your interest to have health problems seen to early before they become persistent and ongoing.
(3) If you require specialized care you may have problems under an HMO plan. You are first required to obtain a network referral. If you secure a specialist outside the HMO health insurance network or do not obtain a referral, any charges incurred with regard to this specialist will not be covered by your HMO Health Insurance plan.
(4) The situations deemed as emergencies under most HMO Health Insurance schemes are not as extensive as under indemnity health insurance plans.

Questions to Ask

In evaluating you HMO Health Insurance plan you need to consider several issues. Firstly, how many medical professionals are included in the network that the HMO Health Insurance plan covers? How do these medical professionals operate – in private or group care surgeries? How many of these medical professionals are currently accepting new clients? What are the requirements and procedures for referral to a specialist? What is the cost of co-payments on medical professional visits and prescription pick ups? Where are the hospitals that service the HMO Health Insurance plan located? What happens if you are out of the area covered by the network and need medical attention?

Major Advantage

The major advantage of an HMO Health Insurance plan is that your medical costs are tightly controlled. Apart from the five to ten dollar surcharge on visits to your medical professional and prescriptions, you may nothing – unless, of course, you require treatment by a medical professional outside of the network covered by your HMO Health Insurance plan. In that case, you pay everything!

The premiums charged by HMO Health Insurance providers varies widely, even within the same local area. It is in your best interests, then, to check out as many HMO Health Insurance policies as you can before making a final decision.

More Articles by Steve Theunissen

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