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eLearning Series:
Your Most Popular Insurance Questions
Answers For Health and Home
Insurance
( 50 articles
in this series )
HMO: What Does
It Mean?
With so many different health insurance programs,
how do you know which one is right for you? HMO is one that
you should become familiar with. HMO stands for Health
Maintenance Organization. It’s a network of healthcare providers that have
contracts with an insurance company to provide their services
at a set price. HMO’s do have many rules that you will have
to follow and do tend to be very restrictive. So how does HMO
basically work for you and is it for you?
HMO
requires that you select a primary care physician who
will manage every aspect of your healthcare 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.
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.
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
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.
So
is a HMO best for you? Or would regular health insurance
be the way you should go? These questions have many various
answers, depending on a lot of factors. If you have a family
buying your own group insurance for your family can get quite
expensive. HMO’s were designed for controlling expenses and
managing all aspects of your healthcare in one place. This
seems to work well with a family. Now as an individual this
may or may not be for you. If you personally have a favorite
doctor or hospital and it’s not on the list of HMO providers
than you probably would better off not going with the HMO system
as it won’t cover doctors or hospitals not listed as a approved
provider.
People for the past few years have watch healthcare costs
skyrocket with no end in sight it seems. HMOs try to
help control costs, which are one of the reasons HMO’s keep
growing and
getting more popular each and every day. The only real disadvantages
with HMO’s are that they can be restrictive and might not let
you do what a normal health insurance company will. The main
reasons is with all the members they have to insured they do
need an across the board rules that everyone can follow to
make it fair to all the people they insure. HMO’s aren’t for
everyone so if you are going to join an HMO does plenty of
research before you join so you know what you will be receiving
and what you won’t be getting. That way you can make an informed
decision on your healthcare needs.
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