HMO medical insurance is a specific type of health insurance product which is both offered and managed by a health maintenance organization or, HMO. This is a specific type of managed care provider.

The HMO type of insurance policy is one that is widely used and is most popular within group health insurance plans; which cover the employees of a company or an organization.

When it comes to an HMO there are both advantages and disadvantages that should be weighed so you can make the right decision on what type of insurance to purchase.

Network of Care

Under an HMO network of care the members of the HMO have access to a network of care provides. There are some cases that the people work directly for the HMO; however, there are the instances where they have contracts with the HMO instead.

The HMO is going to make decisions on what types of treatments it will cover along with the setting in a way to help the management of costs. HMO’s are big on the aspects of preventative care; which is the goal of prevention of expensive medical conditions where possible by working to keep their members as healthy as possible.

Payments and Providers

Being insured under an HMO you’ll pay a fixed-rate fee as an ongoing monthly in order to access providers within the network. Most all HMOs will require their members to pick a PCP (primary care provider). The PCP is the person that is the point of contact for all patients.

When looking to go to specialists the patient usually needs to always see their PCP first to get the referral for a specialist. If you should see a specialist without a referral it is likely that the HMO will refuse to pay for treatment or if they determine that you didn’t require the specialized treatment at all.

There are HMOs that are more relaxed about it and will allow their insured’s to search out the specialists they need to go to directly. It’s important to make sure what your HMO does and doesn’t require before getting any specialized treatment as to avoid not having any of the work paid for.

With your fee, or premium payment, the HMO will cover the costs of your visits to the in-network providers as well as you’re a portion of your prescription costs. The additional is up to the insured which is the copayment for the visit or the prescription.

The copayment is part of the service contract with your HMO so you should make yourself aware of all of the costs and know them before you even go to the doctor or pick u a prescription. The schedules can very dependent upon services and if the insured hasn’t followed proper protocol the HMO can opt not to cover certain things even if the plan would normally have covered said treatment.

Limitations

The HMO plan is one that is very limited in scope. For those that live in a very large HMO approved care provider area they can get an easier access to proper care; however, those that live in more remote locals will find themselves having to travel, sometimes long distances, in order to get access to certain types of treatment.

If you are a person that has very complex medical needs you’ll probably find that HMO health insurance is going to be very frustrating and not a good option if you have a choice. The HMO might not allow you to be able to access certain treatments and your own preferred care provider within your plan.