HMO: The Basics

Also known as Health Maintenance Organization, HMO plans are similar to insurance co-ops; certain physicians and other healthcare providers band together under a particular insurance company. They then offer fixed rates to people that are insured through this insurance company.

It is possible that under an HMO you may not be able to retain the services of your family doctor, if the doctor does not belong to that HMO. In most cases, you will be assigned to a Primary Care Physician. This doctor will be your initial contact for health coverage. In cases where a specialist is required, you will have to first go through your Primary Care Physician to get a referral to the specialist.

HMO plans are usually the least expensive plan to take. The co-payments are usually relatively low, or non-existent, and the premiums are usually less than those paid by a PPO. Many people complain that they feel like they do not get the personal treatment that they are used to under an HMO. It is often the case that physicians that belong to an HMO will keep treatment to a minimum, as they are working for lower rates. They also tend to try and see as many patients per day as they can to increase their company’s profitability.