A health maintenance organization, more commonly known as an “HMO,” is a company that works with insurance providers to make care available within an established network of local medical professionals. Patients rely on a network-approved primary care physician (PCP) to handle their general medical needs. When patients require a specialist, their PCP will recommend another health care provider within the same network.
By keeping patients within the network (and guaranteeing a consistent flow of customers), HMOs are able to negotiate deals with insurance providers that result in lower premiums for customers. Despite the potential for savings, HMOs aren’t the best option for everyone. Learn more about the basics of HMOs so you’re better prepared to select insurance that works for you.
Why Might I Want an HMO?
The main reason that most people elect to sign up with an HMO is to save money on their premiums. This perk is a major draw, but not the only advantage of securing insurance through an HMO.
Other benefits of insurance through an HMO include:
- Centralized Healthcare Services – Information sharing between hospitals, private practitioners and specialists is considerably easier when each of these medical professionals is in the same network. Patients are no longer responsible for transferring health data from one physician’s system to the next.
- Streamlined Care Though PCP – Doctors working within a HMO network are afforded greater influence over how their patients are treated. With one physician managing a patient’s total care, interacting with multiple specialists becomes considerably easier.
- Lower Premiums and Deductibles – Generally speaking, the organization of an HMO network provides patients with more affordable monthly premiums, as well as lower deductibles when they actually visit a doctor’s office.
What Are The Limitations of an HMO?
There are some cases where an HMO offers little benefit to a patient. Individuals must carefully evaluate their own medical history, as well as the plan options available through an HMO, before deciding on which insurance plan is the best fit for their needs.
Potential reasons to avoid an insurance plan through an HMO include:
- Care Limited to Network Members – The major advantage of an HMO is also its major weakness. While members save big when working within their network, they will have to deal with higher prices and limited options when seeking care outside of the HMO network.
- PCP Has Last Word – Specialists under the umbrella of an HMO won’t treat member patients unless they have permission from a primary care physician. While this policy protects patients and physicians, it also creates barriers for treatment when a patient cannot contact their PCP or if they disagree with their primary care provider’s diagnosis.
- Annual Care Limits – Many HMOs set annual limits on how often members can visit the doctor, schedule tests and receive certain treatments. Any instances beyond these limits will result in considerably higher costs for patients, even if they are seeking care within the HMO network.
Requesting Expert Advice on Your Health Care Decision
Extensive research and a strong understanding of your own health needs can help you decide which insurance option is your best choice. You can also rely on the expertise of Addiction Treatment Services.
We specialize in helping those struggling with addiction and their families understand their next step for getting treatment. Often this involves coordinating with insurance companies to guarantee coverage.
Reach out to us online if you have more questions about which types of insurance are the best fit for supporting recovery from addiction.