Health Maintenance Organization Plans (HMO Plans)

An HMO, or Health Maintenance Organization, is a type of group health insurance plan. The medical needs of the people who subscribe are provided by a managed system of medical care. It provides its service for these needs through a group of doctors, medical personnel and facilities that work directly for the HMO. The care of its patients is done at its clinics by its doctors. Each patient is required to pick a primary care physician who will then direct his/her medical needs through one of the system’s clinics. So, it is necessary for the insured members to live or work in close proximity to the clinics or medical facilities.

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How does a HMO help me?

If a person needs routine medical care, he/she would go to the HMO clinic for care, paying a small co-payment at each visit. Likewise, if the person is sick, he/she would do the same. The clinics have many types of doctors who will treat the patient for whatever illness is present. Until recently, few referrals for care outside of the system were given.

Advantages of a HMO

The advantage of this form of medical care includes slightly lower annual premiums, because the cost of care is spread out among the members. In addition, there is little paperwork dealing with insurance forms for the patients. And there is an influence of prevention at an HMO, whereby programs are provided to its members which promote healthier life choices and better health.

Disadvantages of HMO Plans

The disadvantages include fewer choices for medical care outside of the HMO, since referrals to specialists are sometimes limited. If a specialist is needed for an unusual medical condition, the person may want to see someone outside of the system and there will also be a greater cost. The requirement to pick a primary care physician at the HMO may seem inflexible to many also.

For people requiring mostly routine care, people who have no unusual medical needs requiring out-of-network specialists, and people who like their medical care in an organized way, an HMO is excellent.

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