Health Insurance: The Pros And Cons Of An Hmo

There are pros and cons that should be considered when deciding to join an HMO. This article should answer most of your questions regarding HMOS.

Health Maintenance Organizations or HMOs, as they are commonly referred to, are one of the most popular forms of health coverage. One of the main reasons for their popularity is because they are less expensive than other forms of health care coverage. However, just because they are less expensive doesn't mean they are the best choice. There are both pros and cons to enrolling in an HMO.

People often chose HMOs because the premiums are less expensive. In fact, this is probably the biggest advantage to having an HMO. HMOs charge employers a set fee for each employee enrolled in the program. For the employee, these fees are less expensive for them than private insurance carriers. If they get really lucky, the employer will even cover the cost of their HMO coverage.

With HMOs, there is no deductible for the patient. The member pays a co-payment ranging anywhere between $10 - $20 per office visit. Co-payments for outpatient services and hospital services are substantially reduced from what they would be with other health care plans. There is no paper work usually for the patient. All a member of an HMO has to do is present their card and pay their co-pay after the exam. HMOs also, cover most prescriptions for a co-pay that can be as low as $2. This is often a huge selling point to those individuals who require a medication for chronic conditions and for the elderly.



Another positive aspect about HMOs is they pay for programs that are aimed at keeping you healthy such as yearly checkups, gym memberships, etc. They do this so that they will not have to pay for more costly services if members were to get sick. HMOs offer financial incentives to doctors for providing only necessary care. This often alleviates the chance that unnecessary test or operations will be performed.

There are some negatives to joining an HMO. The main disadvantage is that you can only go to prescribed doctors and specialists. There is usually a wide selection to choose from, but if you have a physician that you are familiar with and that physician is not on their list you cannot go to him/her any longer. If you choose to stay with your physician, you will be responsible for the total cost of the visit and any procedures performed. On the same lines, a physician must refer a patient to a specialist. You cannot decide to go see a specialist on your own without this referral or you will be responsible for the total cost. Members even have to have permission from their primary physician in order to go to the emergency room.

The disadvantage to HMO's giving financial incentives to doctors for limited care is your doctor might try and skimp on your treatment. You can't expect treatment on demand either. HMOs require physicians to justify the need for treatment based on benefit coverage by the HMO; therefore, they must get the HMOs permission before prescribing some treatments.

If you are concerned about your privacy, an HMO might not be the right health care plan for you. HMOs use medical records of patients to monitor doctor's performance and efficiency. This means that other people are reviewing your medical history. This means your doctor/patient privilege is violated.

Before deciding to enroll in an HMO, you must decided if the pros out weigh the cons. Can you live with all the negatives in order to get an affordable plan? Will this plan fit your lifestyle? Your budget? These are things that should be considered before enrolling in an HMO or any health care plan.

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