Health Maintenance Organization (HMO) Health Insurance Plans

Getting an HMO may be something that you have been advised to do, but are unsure of  what this type of health insurance really is. Today’s healthcare marketplace is more complex than ever before.

With dozens of different insurance networks, healthcare providers and other related agencies vying for your attention. There is also a vast number of healthcare terminology that you are expected to learn and remember, which can seem like a full-time job in itself. However, there are resources that you can use to better understand these complicated health topics.

Rushing into HMO health insurance coverage without doing the proper research can be a mistake, as you may not be aware of what such a healthcare plan does and does not cover. Different kinds of healthcare plans, such as PPO and POS plans, offer healthcare services that may differ from what you would get otherwise. Learning more about the specific types of healthcare in the U.S. will allow you to make the best decision with regards to the health of yourself and your family. This article will discuss just one of these healthcare types in detail, and inform you of your cost and coverage options regarding that type of care.

What is an HMO health insurance policy?

A Health Maintenance Organization (HMO) is a group of healthcare service providers that allows you to access certain exclusive health services with the assistance of your health insurance. They will require you to choose a doctor to be your primary care physician (PCP), who will be the doctor in charge of monitoring your health through regular checkups, immunizations and physical examinations. Your PCP is also the person that you will need to get a referral from if you would like to visit a specialist under this type of health organization. That is, you will need approval from your doctor if you would like to use your health insurance towards visiting a wrist or eye doctor.

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HMO insurance coverages have many advantages over other plans, in that they are:

  • Usually more affordable. As discussed below, these coverage options have much lower monthly costs associated with them, freeing up money to go towards other things.
  • Flexible, within your network. These plans allow for individuals to access a wide variety of doctors, hospitals and specialists with their health insurance, as long as these locations fall within their network.
  • Good for those who want preventative care. Because visiting your PCP is cheaper with this kind of plan, you can schedule more appointments to help ensure that you are healthy more frequently.

Who is eligible for HMO insurance?

HMO health coverage is able to be purchased by anyone, but that does not mean that it is right for everyone. You should only get this specific form of insurance if you are looking for lower out-of-pocket costs, and willing to sacrifice the ability to go to a wide variety of doctors. When it comes down to it, those who do not have too many healthcare visits per year will spend much less on their healthcare if they get this type of plan. Those who wish to visit a number of different doctors in different networks may need to pay a lot more on healthcare with this plan than with others.

However, although these specialized HMO coverages are very network-specific, there can be certain exceptions to having to pay for out-of-network healthcare. While any non-emergency health service will require you to pay the full amount for the service out-of-pocket, certain emergencies that occur outside of your health network can be covered by your plan. Thus, you should not have to worry about being forced to pay for the entirety of an extreme healthcare bill if the emergency that led to it was not treated by a hospital in your network.

HMO Costs and Coverages

If you want to get an HMO plan, you should first be aware of how much they cost, and what they will be able to cover for those costs. Unfortunately, however, it is not an easy task to learn just how much you will need to pay for this insurance through this article alone. Because healthcare costs change so quickly, the best way to learn the average prices that may apply to you will be to get a quote from an online insurance provider.

On average, HMO costs tend to be about $20 to $30 cheaper per month than their biggest competitor, PPO coverage plans. However, many different factors can change these costs, such as the national economy, any supplemental insurance coverages that you may have, whether or not you are on Medicare and more. Your coverage options under this type of insurance are limited to whatever is covered under your insurer’s network. You can always utilize out-of-network services, but be aware that your insurance will likely not chip in towards those costs.

How to Get HMO Insurance Plans

To see the HMO insurance plans that might be right for you, online quote searching is the best place to start. Look for a coverage option that fits within your preferred health insurance network, and has reasonable monthly premiums and deductibles. However, you cannot always buy a health plan at any time. Near the end of the calendar year, health insurance companies across the country have their “open enrollment” period. This is the time to find and purchase your new health insurance policy for the upcoming year, or to adjust the policy that you are already paying for. While there are some special enrollment dates for getting married, moving, having a child and more, you should plan on purchasing your new plan during open enrollment.

Luckily, as HMO health insurance is open to anyone, you cannot be turned away from purchasing a plan for any reason. This even applies to those with long-term conditions, life-threatening illnesses, pregnancies and more. All you have to do is check out the U.S. government’s online healthcare marketplace, see if you get any discounts due to your household income, look at the many different plan options and pick the one that looks best to you. Getting the right plan is important, not only because you will be paying money for it every month, but also because it could be the difference between affording a crucial health treatment and not being able to get it. In this way, HMO health plans are an excellent investment for people who need health insurance.

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