Health Maintenance Organizations (HMOs)

What are Health Maintenance Organizations (HMOs)?

It is not that difficult for an individual planning to obtain health insurance to find the best insurance providers. They check and compare the features as well as prices of different Insurance companies and buy an insurance policy from the best company. Health Maintenance Organizations term is one such popular and effective health insurance service provider. You can find HMOs in the Health Insurance Marketplace.

They are known for Offering monthly or annual health coverage plans. It is important to note that health maintenance organizations offer policies that cover a specific network of healthcare service providers and physicians. They already have a contract with certain specialists and physicians. So, your plan will be limited to the doctors and hospitals that have signed a contract with the HMO.

HMO Subscribers

The main benefit of this health insurance is that you get to pay a lower premium than the standard insurance fee. That’s because the HMO directs the insured people to particular medical healthcare sectors and physicians. However, it also comes with its share of drawbacks. For instance, the members that have signed up for the HMO health insurance plan are not allowed to get medical treatment outside the network.

If they do so, they will not be eligible for claiming health insurance. In order to determine if the health maintenance organization is a perfect option for the health insurance plan, you must take a few important factors into considerations. This includes your healthcare requirements, the complexity of a pre-existing medical condition, the hospitals and doctors included in the policy, the cost of monthly or annual premiums, and more.

The Working of Health Maintenance Organizations

HMO can be defined as an organization that caters to the financial requirements of the patients who need medical care. It includes both public and private groups that sign a contract with medical specialists, physicians, and other professionals. The hospitals and physicians that have signed an agreement with the health maintenance organizations get a specific fee for offering medical facilities and treatment to patients that are part of the HMO. That way HMO manages to provide its subscribers with a quality medical care plan, while charging the lowest possible premiums.

People who plan to join the HMO network needs to subscribe for either the monthly or annual plan of the organization to get quality medical treatment. However, the members can only get these facilities from doctors and hospitals included in the HMO’s healthcare network. The subscribers are also required to be within the HMO network to be eligible for the Insurance Claim. If the member needs emergency medical care while being out of the network, the health maintenance organization will cover the expenses.

For any casual and non-emergency medical requirements, you won’t be paid a single penny if you decide to get medical services outside the HMO’s network. HMO plans do not involve deductibles. The plans are quite affordable for patients. It only involves co-payments of $5-$20. The rest of the expenses will be financed by the HMO.