What is an HMO plan? What does an HMO plan cover? How much will it cost me?
What is an HMO Plan?
A Health Maintenance Organization (HMO) plan is a plan that provides its members with a network of healthcare providers (primary care doctors, hospitals, specialists, etc.) HMOs provide broad preventative coverage and usually have lower monthly premiums, copays, and deductibles than other plans, like PPO plans. But, HMOs are generally less flexible than PPOs as well, because they do not allow their members to see out of network healthcare providers. But, many HMO plans have a wide network of providers and are able to keep costs for those providers very low.
How do HMO plans work?
An HMO plan is designed to keep your insurance costs low and without any surprises. When you start an HMO plan, you are required to select a primary care provider (PCP) who will be your primary doctor, handling your routine check-ups, physicals, minor illness and injuries, etc. On an HMO plan, you generally will not be allowed to see a specialist directly, and are required to go to your PCP first, and then get recommended to a specialist if necessary.
Although this plan is more restrictive than other plans that allow their members to go to specialists without a referral and don’t require a PCP, the difference is, that with an HMO plan, you will typically have much lower out-of-pocket healthcare expenses. You also will not be required to pay for services up front and then submit claims forms to your insurance company like many other plans require. This makes HMO very cost effective, and a great option for anyone on a tight budget or for someone who just needs routine preventative care.
Who Should Use an HMO Plan?
HMO plans are excellent options for:
- Anyone looking for a plan with a lower premium. If premium expenses for other plans seem too high, an HMO plan can be an excellent option for you to get the healthcare services you need without breaking the bank
- Anyone who just needs routine care like vaccinations, checkups and physicals, etc. If you don’t regularly need to see specialists, and HMO plan that covers routine care through a PCP can be a good option
- Anyone who doesn’t have preferred doctors that they want to continue going to. If you have a doctor that you like and want to keep seeing, you may find that that doctor is not in your HMO network. So if you want to continue seeing your doctor, you should first check if they are in the network, and if not, you may want to consider another plan like an HMO
- Anyone who doesn’t plan on travelling or moving. If you are planning to leave the area where your health insurance provider has a network, you may find yourself in trouble if you need healthcare and are not able to find a local in-network provider. If you anticipate traveling or moving in the near future, it may be better to go with a plan that allows you to go out-of-network for services.
HMO Plans: What else should you know?
Many HMO plans offer personalization options, allowing you to choose any primary care doctor within the network, and giving your family members the option to choose different primary care doctors as well, if you are on a family plan. You also usually have the option to change your primary care doctor at any time, and go for appointments at any time. Because of the low cost and personalization options, HMO plans can be an excellent choice for many people.
Although HMO plans many not be as flexible as some other types of plans, they offer good coverage at a low price and are a great option for anyone looking for healthcare on a budget. HMOs give you access to a PCP who will get to know your medical history, and become your personal doctor; they give you access to a wide range of healthcare providers; and they keep your premiums, copays, and deductibles to a minimum.