Health Maintenance Organization (HMO) Plans

A Health Maintenance Organization (HMO) is a kind of managed care organization. Physicians and other providers contract with particular insurance companies to provide service at a reduced cost in order to increase their patient load. This savings is often passed on to employees who enroll in the program. Most services are paid for with a single, small co-payment. Costs vary, but range usually between $5-$25/service.

In exchange for a lower cost, enrollees in an HMO agree to follow the rules of the contract, which include maintaining a single contracted physician for services. Coverage is not supplied to members who decide to go to another doctor, unless they are referred by their primary care physician or they are involved in an emergency. Pregnant women are allowed to choose, however, their OB/GYN provider.

Request more information on CA HMO Options >>

HMO Plan Details

While HMOs have traditionally been offered in the small group environment, more and more insurance carriers are beginning to offer Individual HMO coverage options. This doesn't decrease the limitations, however, so if you decide on an HMO, make sure that you are making an informed choice.

The big advantage to choosing an HMO is the cost. Premiums are usually low and co-payments are low or free. Coverage is comprehensive and focuses on wellness visits and preventive services rather than catastrophic coverage. The goal is to keep you healthy so that there won't be any large costs on either side. However, it may be more difficult for you to make a quick appointment, as HMOs usually have a long line of clients waiting to see a limited number of doctors. And because they charge less for each patient, physicians' offices are more likely to feel pressured to speed people through to make up the difference. To avoid these problems, request an emergency visit if necessary, and discuss any issues or questions you might have before the doctor begins his/her examination.

A Health Maintenance Organization is the best choice for you if you expect to be making regular or frequent trips to the doctor and 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. In addition, HMOs have no claim forms for office visits or hospitalization, so trying to keep a toddler appeased while filling out paperwork isn't an issue.

Request more information on CA HMO Options >>