An Overview of HMO Health Insurance

health insurance hmo

HMO health insurance requires that you select a primary care physician who will manage every aspect of your health care needs. This primary care physician must be a member of the HMO. The disadvantage of this is you may have to switch primary care physicians until you find one in the network that is near you unless you want to travel. If the physician isn’t in the network of HMO’s then the work will not be covered under your insurance plan. If you need a specialist for anything you must first get a referral from your primary care physician.

Health Maintenance Organizations or HMOs are managed care organizations that issue a form of health insurance coverage through doctors, hospitals and other health providers that have a contract with them. In 1973, the HMO Act required employers with at least 25 employees to provide federally certified HMO options. HMOs follow a set of guidelines for health care that is provided through their network of providers. In this model, providers contract with an HMO to have more patients and receive in return discount for services.

HMOs gain an advantage over traditional insurance plans by managing the health care of their patients and there by reducing services that are not necessary. Medical needs must initially go through someone who authorizes referrals to doctors or specialist if necessary. Emergency medical care does not require this authorization.

HMO’s main advantages over the other programs, is the cost. HMO’s are cheaper for the consumer and premiums are a lot cheaper with an HMO. Co-payments are usually low cost or free, so this is a big selling point to consumers as less out of pocket expenses are something today’s consumers are looking for. HMOs are designed for profit so you can expect your doctor to be very busy, as he has to see many patients since the goal of the HMO is to turn a profit. Doctors tend to want to spend more time with their patients but that’s not always possible as HMO’s need to turn a profit or will be forced to close. Employers pay a portion of the monthly fee that is required to join the HMO health insurance plan. Usually whatever is left is the employee’s responsibility to pay weekly out of their paycheck.

Co-payments are a big issue in most HMO’s for a number of different reasons. The main reason is that a co-payment sometimes deters people from using the service. For example hospital co-pay is a lot more expensive which tends to get the person wait and go to his primary care physician, as the co-pay for your doctor is a lot less. This seems to work well in the HMO health insurance scheme of things. Co-pays are also used to offset the overall cost of the insurance and makes everyone pay their fair share which forces the people who use it the most to pay the most into the plan.

See Also : Health Minerals

Executive summary by Doel

Based on article healthinsuranceinfoonline