What Is An HMO Plan?

Health Maintenance Organizations are among the most affordable kinds of health coverage available. Out of all your health plan options, HMOs usually have the lowest premiums and co-payments. They also have the tightest restrictions on which healthcare providers and services will be covered.

Like PPO plans, HMOs are managed care organizations. In a traditional health insurance plan, members could see any provider they chose, and receive any service that their plan covered. In managed care plans, you choose from an approved list of providers — called a network. Specialist and hospital services must be approved by your primary doctor and, in some cases, by the plan administrators.

Despite these limitations, HMO plans remain popular. People choose HMO plans mainly because they provide to access to care at prices much lower than traditional plans or even PPO plans.

HMO Advantages

HMO health plans have these advantages:

• Low out-of-pocket costs — doctors visits are often as low as $10

• No deductibles — most HMO plans give you full coverage without you having to meet any deductible

• No lifetime maximums — unlike plans that will only cover a certain amount, HMO plans don’t cut off coverage

• Little or no paperwork — HMOs don’t require you to complete complicated forms to file a claim

Things You Should Know About HMO Plans

Like all managed care plans, HMOs put their emphasis on primary care. The goal of HMO plans is to keep costs low by keeping its members healthy.

When you enroll in an HMO, you choose a primary care physician. Primary care physicians are usually general practitioners, pediatricians, or family doctors. Your primary care physician becomes your main point of contact with the healthcare system. Their approval is needed for the plan to cover any specialist care or hospital services. If you have a chronic condition that requires regular specialist care, you can often choose a specialist provider as your primary care physician.

A key difference between HMOs and other managed care programs is that healthcare services you get from providers outside the network aren’t covered. This means it’s important to find a doctor you trust — and is convenient for you to get to — within the network. But this isn’t a problem for most people.

Before you enroll, you should learn more facts about HMO plans. You can also talk to insurance agents to find if an HMO plan is a good fit for you. To get connected with local agents now, use our free service to get insurance quotes.