HMOs, or Health Maintenance Organizations, can vary widely from other health insurance plans such as individual plans, PPOs, and indemnity plans . Due to these differences, HMOs have numerous pluses and minuses which need to be considered to determine whether an HMO is the best plan for you and your family during enrollment.
HMOs have been very popular for many people due to their lower premiums and lower co-pays for office visits. However, these lower costs are derived from the agreements that health insurers negotiate with businesses and other organizations which can lead to strict and specific coverage options which may not be appropriate for all members.
Ease of access and lower costs when seeking health care services are a primary benefit that patients seek which makes life easier for the patient. Often an office visit to a primary care physician can be as easy as scheduling an appointment, paying a co-pay of between $10 to $20 dollars, and presenting a medical insurance card. Prescription costs can also be as low as a few dollars which is especially helpful for patients who may have many chronic ailments.
Health insurers keep medical costs down by ensuring patients receive timely and efficient health care aimed at preventive services. The doctor patient relationship is examined often to determine overall effectiveness in maintaining patient health and a limited number of practitioners and specialists are used for cost reductions.
While the many positives for HMOs can be influential when choosing a health insurance plan those same positives may the negatives for other individuals. The cost savings by being a member of an HMO may not be worth the trade offs of limited physician selection and an inability to go directly to specialists to seek additional treatment . Many HMOs require preauthorization for certain treatments and access to specialists to ensure effective use of limited resources.
If you have a favorite physician or specialists that you see often and they are not on an approved list then additional costs could be incurred. The full cost of the visit or procedure may have to be paid in full by the patient. Also, treatments and procedures often times need to be requested by the physician and approved by the Insurer.
Choosing an appropriate health plan is really a matter of what is important to you in health care treatment and physician access. The gain in lower co-pays and premiums may be offset in limited access to physicians, specialists and access to additional treatment options. It may wind up being better going with a PPO or high deductible plan depending on your current health situation and financial resources.