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Should I Enroll in HMO Insurance?

When people begin to look at healthcare for their families, many ask the question, “Should I enroll in HMO insurance?” It’s a fair question, given that there is so much buzz around it.

Due to bundled their large network, bundled services, and the economies of scale, HMOs are able to offer compelling benefits at a lower cost than many other forms of healthcare. Depending on your situation, they could be a great fit for your family.

What Does HMO Stand For?

For starters, if you’re not already familiar with the acronym, HMO stands for “health maintenance organization.” The name reflects a core tenet of their philosophy. In a nutshell, the emphasis of HMO networks really is on the word “maintenance.”

HMOs primary goal is to maintain you and your family at a healthy level, in order to avoid and minimize catastrophic accidents, illnesses, or injuries. Apart from being a great thing for the patient, this obviously helps the insurance company to save larger amounts of money down the road, by spending smaller amounts upfront.

How Does HMO Insurance Work?

HMO insurance is largely facilitated through employee insurance plans in the workplace. In HMO plans, you will be given (or can choose) a primary care physician. This doctor will be your point of contact for virtually any kind of illness or ailment.

If you require special care or treatment for something above and beyond the specialization of your general care practitioner, then he or she will refer you to a specialist. If the doctor declines to refer you to a specialist, then the HMO network will assume it is not medically necessary, and typically not pay for that service or treatment.

Keep It In Network

The biggest thing to remember with HMO insurance is that all of the care that you receive must be “in-network.” This means that the care and services that you receive need to be provided by doctors that have an agreement in place with the HMO.

If you happen to need something that is out of the network, you are own your own, and must pay for it on your own. Obviously, this holds true even if you forgot, or were under the impression that a service was supposed to be covered, but later wasn’t.

This single aspect is the largest drawback to HMO plans. As a member, you are limited to the network, and there is little opportunity to extend your care or coverage outside of it.

Can you switch doctors?

Yes, of course. If you feel the need to change your primary care physician, you are welcome to switch, AS LONG AS the new doctor is within the HMO network. Sound familiar?

HMO vs. PPO - Which is Better for Me?

The biggest differences between an HMO and a PPO are:

  1. Breadth of care available
  2. Cost

Unlike an HMO, in a PPO (Preferred Provider Organization), members are given significantly more flexibility in seeking out and obtaining care. Typically, with a PPO, you do not need to be assigned a primary care physician, or receive referrals in order to receive the care that you want.

In exchange for this flexibility, the monthly premiums with a PPO are also significantly higher as well. This precludes PPOs from being a viable option for many individuals and families, simply because it is not affordable for them.

What is My Next step?

For many folks, the choice between an HMO, PPO, and a POS is a critical one. On that decision ride a multitude of other options relating to the type and level of care that you are able to receive.

What some people don’t realize however, is that there may be an even better option for your family. Depending on your medical history and your needs, there may be an even better way to receive the care that is important to you, while still maintaining significant savings.

Our healthcare advisors are standing by to assist you in selecting the care that best fits your family. Contact Highland Health Insurance today, and in with just a brief conversation, we will share our best tips and recommendations, to ensure you get the care that’s right for you.

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Speak to a Live Agent instead.
Call (866) 428-2888
We make it easy to find a plan that’s right for your budget and your needs.