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Will an HMO Be the Best Health Plan For You?

By Marilyn Katz

Republish: EasyPublish™
Published: 15Nov2008
Word count: 508
Viewed: 352 time(s)

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A Health Maintenance Organization (HMO) is a type of managed health care plan. An insurance policy is combined with a network of medical providers like doctor's, hospitals, and pharmacies. The network providers agree to the network policies for providing care and setting prices. In return, network providers get added to the list which should provide them with a steady stream of patients.

Because of this arrangement, the medical provider can keep attracting patients, and perhaps save some costs associated with that activity. A doctor's office, for instance, that can count on a steady stream of regular patients, may be able to charge less for an appointment than a doctor's office without a full schedule.

The network gets to manage costs and care, and that way they can contain costs and improve efficiency for themselves, and for their covered clients.

The health plan participants must use the network providers in order to have their health care covered in most cases. This restriction also allows the health care plan to manage costs. Exceptions are made to the network coverage policy in the case of an emergency. Sometimes, if a particular medically needed service is not provided by the HMO, an exception will be made to the network restriction as well. In any case, if the insured person needs to seek care outside the network, in a non-emergency situation, the service should be pre-approved, in writing, by the health plan's administrator.

HMO plans work well for many people. Most of us are used to choosing a primary care doctor from a list that our insurance company provides us. We are also used to accepting that professional's advice when we need to see a specialist. For people that live in an area where an HMO has a large network of medical providers, it is usually no problem to find quality care for a variety of medical needs.

Insured people enjoy lower premiums and copays in return for accepting tighter network restrictions and managed health care. In addition, patients usually do not have to complete much paperwork as all forms are handled by the doctor's office and insurance company.

However, people who do not live by a large and active network may not be satisfied with their available privders. In particular, people who need to seek specialized medical services may have to travel or have trouble obtaining a referral to a specialist outside of the local medical provider network. If a situation comes up where an HMO participant wants to see a particular doctor who does not work with the network, they may have to pay the full cost of the appointment and associated costs if they cannot get an exception approved.

The health plan that will satisfy you, and your family really depends upon many factors. Your age, gneral health, and the available plans in your area will affect your choice. But for those who live close to a large network of providers, and who usually only need routine or typical medical care, an HMO can be a great choice.

Pick the best HMO health insurance, or find out if an HMO is right for your family with our free individual health insurance quotes.

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