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What is HMO Insurance?*
HMO stands for Health Maintenance Organization. An HMO insurance plan offers healthcare services through a network of providers who agree to supply services to members. With an HMO you’ll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan.
How Does a HMO Insurance Plan Work?
When you have a HMO plan, you’ll be required to choose a primary care physician (PCP). You have the right to choose your own PCP as long as he or she is in the HMO’s network. If you don’t choose one yourself, the HMO will assign you one. Before you can see a specialist, you’ll need to obtain a referral from your PCP.
You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. You also typically won’t have to submit any of your own claims to the insurance company. However, keep in mind that you’ll likely have no coverage for services given by out-of-network providers or for services received without a proper referral from your PCP.
Is a HMO Plan Right for You? Advantages of using a HMO:
- Lower premiums
- No deductibles
- Access to preventive care services (checkups, immunizations)
What is the Difference between HMO & PPO
The main difference between HMO & PPO plans is the flexibility to choose. With a HMO plan, you must choose doctors, hospitals, and other providers in the HMO network. With a PPO plan, you can choose doctors, hospitals, and other providers from the PPO network or from out-of-network. If you choose an out-of-network provider, you most likely will pay more.
Which Plan is Better for You?
PPO plans give you flexibility. You don’t need a primary care physician. You can go to any health care professional you want without a referral—inside or outside of your network. Staying inside your network means smaller copays and full coverage. If you choose to go outside your network, you’ll have higher out-of-pocket costs, and not all services may be covered. The bottom line – if you’re looking for low cost health insurance, a HMO is probably best.