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HMO's (Health Maintenance Organizations)

What You Need to Know About HMO Health Insurance

Understanding HMO health insurance does not have to be confusing or baffling. HMO stands for Health Maintenance Organizations and they are a form of managed care. Under HMO health insurance plans, doctors and other health care professionals contract with the insurance company to provide medical treatment and advice to their HMO health insurance customers.

HMO plans are a kind of managed care health insurance plan. HMO's, also known as health maintenance organizations, are companies that have contracts with doctors and other health care providers and they are directly involved in the medical treatment of their customers.

While HMO plans are generally the most affordable kind of coverage available, they are also the most restrictive. These usually have a deductible but no coinsurance requirement.

How HMOs Work

Most of these plans require that a primary care physician (PCP) be designated by recipients who join the HMO. That physician is the gateway to all health care providers. If you are a member of an HMO, your primary care physician and all referrals must be members of the network that the HMO plan has contracted with to provide services.

If an HMO member tries to visit a medical practitioner with no a referral from the PCP, the visit or treatment will not be paid for by the policy. This is a primary crticism of HMO's because it greatly limits the freedom of the insured individuals when it comes to controlling their own health care needs.

HMO and PPO plans, also known as preferred provider organizations, use management controls such as the PCP limitation and a focus on preventative care to lower the cost of healthcare.

HMO plan members pay a monthly premium regardless of their medical needs. In return for the premium, the HMO provide various medical services, from checkups to surgery. Medical services are normally only paid for if the person uses a provider in the HMO network and goes through their primary care doctor. Network sizes vary widely, so be sure to check the list of health care providers in your area.

Advantages and Disadvantages of HMOs

Though HMOs have been widely-criticized in recent years, they are still a very popular and effective type of health insurance coverage for many people. Below is a list of advantages and disadvantages of HMO medical plans that should be considered when deciding if this type of coverage is right for you.


How Affordable are HMO Health Plans?

HMO medical insurance is often considered to be the least expensive type of medical insurance available to most people. However, these policies are also some of the most restrictive, meaning you may not have as much freedom in choosing your own doctor or hospital. Most HMO health insurance policies also require a certain deductible or co-pay to be paid by the customer. The amount of the deductible or co-pay varies from policy to policy.

How Does HMO Insurance Work?

It all begins with your primary care physician or PCP. When you purchase an HMO health insurance policy, your PCP should be a member of your HMO network. Any referrals made by the PCP must be made to other professionals or facilities that are members of that same network, and your HMO medical information will go with you to any referral, which is another way these policies save on costs.

If you go to another physician who is not a member of your network, the policy may not pay the cost of the visit or treatment received.

Under your HMO health insurance plan, you may pay a monthly premium, which may cover various medical services including preventive care procedures.

The Cost of HMO Health Plans

It is fairly easy to get HMO insurance quotes. Free HMO quotes can be gathered online and used for comparison purposes. It should be noted that HMO medical insurance quotes are often dependent on the customer's current health. Do not be surprised if part of the process of getting HMO online quotes involves answering some health-related questions.

As you search for HMO health insurance quotes, remember to look for network plans that are available in your geographic area. For instance, if you have a particular physician you want to use, make sure you join the same network that he or she belongs to. Most HMO insurance online sources may make this work easy for you as they have this information readily available. For the vast majority of relatively healthy adults, getting HMO quotes is an easy and fast process.

Is Affordable HMO Insurance Available?

It is available, but do careful research  before buying into one of these programs. You want to carefully examine the services that are offered as well as the co-pay or deductible, which may be high. You may also want to carefully read the various definitions of the services that are offered. This can be especially important for topics such as emergency room visits and diagnostic tests. You want to know before you buy into the program what is covered and what is not covered.

At USInsuranceOnline, HMO health insurance quotes are provided by licensed agents and brokers that partner with us to help consumers compare rates and save money.


Advantages of HMOs Disadvantages of HMOs
Preventative Care
HMO plans encourage members to seek medical treatment early and to have annual checkups. They are focused on wellness and many HMOs offer information to their members about staying healthy.
Primary Care Physician Gateway
Specialized medical attention can be more difficult to obtain with an HMO plan. The PCP is the access to all health care services you can't see a specialist without a referral. This helps the health insurance company reduce expenses for its HMO members and the company.
Least Expensive Health Insurance
There is usually not a coinsurance requirement with HMO plans. Instead of a deductible, most HMO plans have small co-payments for medical services and treatments. So, regardless of your medical needs, a HMO plan will probably just charge you the monthly premium and a small co-payment.
No Coverage for Out-of-Network
HMOs will probably not cover a visit to a doctor who is not in the HMO network, even if there are no network providers in the area.
No Lifetime Maximum Payout
Unlike other health insurance plans, many HMO policies do not have a lifetime maximum payout. They will pay for your medical needs as long as you are a member.
Strict definitions
The definitions for HMO plans tend to be limited. For example, an emergency room visit may only be covered if it meets the company's definition of an emergency, which could be surprisingly restrictive.
Less complicated billing
Billing systems for HMOs are usually less complex than other programs, so customers experience less problems.
More difficult to change doctors
Many HMOs discourage you from changing primary care physicians. You may be limited to changing your primary care doctor once or twice.
Patient quotas
Physicians who participate in HMOs are often required to see a minimum number of patients every day. This could limit the time your doctor can spend addressing your needs. Some doctors receive a particular amount from a HMO plan regardless of the number of patients they see, making it preferable for the doctor to have less appointments.
Many HMOs require that diagnostic tests be approved before they will be paid for. This could delay your health care treatment.

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