What Exactly is A Health Maintenance Organization (HMO)?

Health Insurance

Most of us have heard of an HMO (Health Maintenance Organization) but not everyone is aware of the details and requirements unique to these health groups.  Simply put, a health maintenance organization (HMO) is a network that provides health insurance coverage at a set monthly or yearly fee. An HMO consists of a group of medical insurance providers that limit coverage to medical aid provided from doctors under the terms of the HMO plan. These contracts usually result in lower premiums because the health providers have patients sent to them.

As a patient looking for an HMO plan, there are some key things to keep in mind. It is always important to consider your current general health and any out of pocket expenses you presently pay. Also, do you require any special care? Does having your primary care physician in your network make a significant difference for you?

A person’s coverage under a health maintenance organization has some restrictions. For example, it may require the insured to live or work in the plan’s geographical area to receive coverage. In cases where a subscriber receives emergency care while out of the HMO region, the plan may cover the expenses. Any non-urgent out-of-network care received will usually be the responsibility of the patient. These scenarios are why it is essential to do your research before choosing a plan.

If you opt for an HMO, the patient must choose a primary care physician (PCP) from the network of local healthcare providers. A general practitioner is typically an individual’s first point of contact for health-related issues. This means that an insured person cannot see a specialist unless the PCP refers them to a physician. However, certain services, like a mammogram screening, usually does not require a referral.

If you are searching for a health insurance plan and have any questions about an HMO or other topics, contact Fast Health Insurance. Their agents are aware shopping for insurance raises many questions. Fast Health Insurance  will sit down with you and explain all your options and clear up any confusion. Relax and take comfort in knowing Fast Health is attending to your needs. Give them a call today at 630-688-2452 or visit their website for more information.

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