Health Maintenance Organization (HMO) Plans
A Health Maintenance Organization (HMO) is usually the cheapest option, and provides the most services. They are cheaper because physicians will often join the HMO to increase their patient load. Most services are paid for with a single, relatively inexpensive co-payment. Costs vary, but range usually between $5-$25 per service.
In exchange for a lower cost, members of an HMO plan agree to maintain a single chosen physician for services. An enrollee does not have the freedom to go to a doctor other than the single doctor they choose from the plan, unless their primary care physician refers them or they are involved in an emergency. The only exceptions are pregnant women, who can choose their OB/GYN.
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HMO Plan Details
While in the past HMO plans were usually only offered in the small group environment, more insurance carriers are beginning to offer Individual HMO coverage options. HMO’s are still limited in their selection of doctors, and it is never safe to assume that a doctor you currently use accepts HMO unless you ask.
The big benefit to choosing an HMO is the low cost. Premiums are usually relatively inexpensive and co-payments are also cheap or even free. Coverage is broad and focuses on general visits and preventive services rather than extreme coverage. The goal is to keep you healthy so that there won't be any large costs on either side. The downside is that it may be more difficult to make an immediate appointment, since HMOs usually have a long line of clients waiting to see a limited number of doctors. Because the doctors and healthcare facilities charge less for each patient, visits may feel rushed to speed people through to accommodate the high volume of patients. To avoid these problems, request an emergency visit if necessary, and always go prepared with a list of your concerns and questions you want to ask.
A Health Maintenance Organization is the best choice for you if you want a low cost plan, you aren’t attached to a physician that does not accept this plan, and if you don't mind sticking with one doctor for all of your coverage needs. If you have young children, an HMO might be your best choice because immunizations and child well care is usually included at a 100% rate with no deductible.
