What is an HMO?
Filed Under (HMO Plans) by Group Health Insurance on 17-03-2009
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Health Maintenance Organization Plans – HMO Plans for short – are a type of managed care program. The idea behind managed care programs is that maintaining good health will be achieved by preventing disease and providing quality care. By maintaining good health, it is believed that escalating health care costs can be controlled.
Being managed care plans, HMOs only allow members to visit a contracted network of providers for benefits: the use on non-contracted is not covered.
At enrollment, members are required to choose a Primary Care Physician (PCP). The PCP is often called a gatekeeper as they must provide referrals to in-network specialists if they feel the patient requires the services of that specialist.
Your primary care provider is available to see you for basic care and for an illness. Primary care providers run tests or prescribe treatments before passing you on to a specialist.
HMO’s vary in the structure of their networks. Some are very tightly structured so that all care is provided by the HMO’s employees in that HMO’s hospitals or clinics. Other HMO’s are more flexible in that they include cooperative agreements among independent doctors, hospitals and other health care providers.
As stated previously, the idea behind an HMO is that to keep costs low. With this in mind, HMO’s believe it is necessary to provide preventative health care before a member falls ill. HMO’s are built upon a network of hospitals and physicians who are interested in providing health care to members in exchange for a monthly charge paid to them by the HMO.
Members may see their primary care doctor as often as necessary, paying the HMO monthly premium plus a small additional fee per visit or prescription. Most health and wellness services are covered.
HMO plans simplify your decision making and you pay predictable costs. Co-pays are minimal and there is usually no deductible.
