

What is HMO Insurance?

To manage the rising cost of healthcare the Health Maintenance Organization (HMO) Act was created in 1973. HMOs healthcare initiatives place importance on preventative measures offering affordable medical services for individuals and families. Predicting the unforeseeable is difficult, but major risks associated with well-being can be reduced with healthcare insurance.

HMOs have their own set of guidelines and restrictions requiring patients to use specific facilities and designated physicians when receiving medical services. The only exception to the rule is emergency care or dialysis facilities within or outside of the approved network can be used.

Patients opting to use HMO medical services pick a primary care physician (PCP). The purpose of doing this is to ensure customary medical practices are provided to maintain a patient’s good health, preventing unnecessary cost or health burdens to the patient. Down the road, the doctor will refer patients as needed to a specialist or other care providers within the network. HMO networks consist of industry certified physicians, specialists, hospitals, clinics and other medical facilities.

Anatomy of HMOs

Financially, payment for services per individual or family is paid monthly. The cost is fixed for the period of time no matter which network service the patient uses. Because the services are administered under the guidelines of HMOs facilities the premium costs are lower compared to other healthcare plans. The benefits include access to experienced doctors and hospitals without lowering the quality of medical services.

Growing families and particular case individuals have access to regularly scheduled office visits and medical routines. Children go through frequent illnesses as part of their development. This is where the managed care from the PCP determines the need for a specialist and refers you to an in-network care provider.

All managed healthcare plans vary in benefits, premium costs and out-of-pocket expenses. Most HMO plans have low copays and no deductibles. It’s important to review the medical plans, and the choices offered to find the best fit your lifestyle.

For many HMO plan members, the service simplifies going to the doctor. If you like having a PCP manage your health a HMO plan may work for you. If your PCP leaves the network, you will be notified and you’ll need to select another PCP.

Managed Health Insurance

Health insurance helps to protect your health and manage the cost of medical care. You can buy into an employer’s plan or purchase your policy; each has provisions for sharing the cost of expenses.

  • HMOs are less expensive than most insurance plans.
  • There are HMO programs for Medicare and Medicaid.

Medical billing systems are easily managed since the providers are part of the network. It makes the administrator’s job easier and removes the patient’s frustration or worry about filing claims and paying service bills.

HMO Elements

Plans include routine physicals and pediatric care as part of the wellness process at no additional cost. Some HMO plans specify a facility depending on where you live the location may require driving. If you have pre-existing conditions, ask about the medical coverages including medical transportation if you live in a rural area. Find out if there are additional costs for services before signing the plan’s policy.

  • Read the terms and restrictions for approved services. 
  • Ask questions; this is about your health.

Having insurance helps to pay for the unexpected cost of recovery insurance also protects against the financial burden of medical bills.

We all need medical care to prevent health conditions from getting worse. It is essential to understand how your managed care plan works to keep you and your loved ones healthy. Selecting the best option increases your chances of staying healthy. The choice is yours if you don’t mind seeing your PCP first before going to a specialist within the network to manage the costs.


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