Health Maintenance Organizations (HMOs)

Health maintenance organizations (HMOs) are managed care organizations that provide employees in mid-size and large companies with medical coverage. Employers are able to obtain these plans at much lower rates because there are a number of restrictions placed on the type and amount of care that doctors are allowed to deliver.

Under HMOs, two main limitations are placed upon the healthcare that employees are eligible to receive. First of all, HMOs contract with certain health care providers only. This means that the mass numbers of people enlisted in an HMO plan are restricted as to who they can see about their medical ailments.

Secondly, those covered by HMOs must select a primary care physician. This doctor can be an internist, family practitioner, or general provider. You are expected to initially visit this individual with your medical problem, and he or she will then refer you onto a specialist that is covered by your plan.

Certain treatments that are deemed unnecessary will not be covered by your HMO plan. If you have a known condition, then it is very important for you to check your plan’s coverage for this illness before you agree to receive treatment. Otherwise, you run the risk of being stuck with massive medical bills and no help in paying them off.

There are arguments for and against HMOs. They typically have lower premiums, so they can be cheaper for both you and your employer. However, there are many hassles associated with HMOs, as well. Many complain about the restrictions they have regarding who they can see and what treatments are covered. It can also be quite inconvenient to visit your primary physician before receiving specialized care.

Contact Us

If you would like to learn more about HMOs and how private health coverage might benefit you, then Catherine Michaels Insurance Services can help. Contact us at 888-875-9888 to speak with a qualified representative today.