Finding the insurance company that is right for you, and that will accept you, can be difficult. In addition to learning about what it will cost, you need to find out what kind of health insurance that company is offering you. One of the most popular forms of health insurance is something called an HMO.
What is an HMO? It stands for Health Maintenance Organization. The HMO contracts specific doctors and hospitals to provide health care for a discounted price to the people who purchased the HMO insurance. The doctors and hospitals, in return, are expecting to get more patients sent to them from the HMO. If your health insurance is part of an HMO, you will have to select a primary care physician. You are expected to visit this doctor for all of your health care needs. If the doctor decides that you need care from a specialist, the doctor will refer you to a specific specialist doctor. You must wait for your primary care physician to make that referral before you can go visit a specialist. You may or may not be required to pay a copayment when you visit your primary care physician.
There are advantages of choosing health insurance that is part of an HMO. The biggest benefit of going with an HMO is that it allows for some control over medical expenses. You will pay the same amount to your insurance company no matter how many doctor visits you end up needing. Most HMOs do not require members to pay deductibles. This type of insurance is required to cover all of your medical expenses, as long as you are using doctors and hospitals in the network, and they do not have a lifetime limit of payouts. You also will not have to fill out insurance forms, and then submit them, after you receive health care. If you have insurance from your employer, it is probably an HMO.
There are some disadvantages to going with an HMO. If you need specialized care that is not something that can be provided by a doctor or hospital in your network, you will be paying for the entire cost of that care, out of pocket. You also are required to wait for your primary care physician to make a referral before you see a specialist. If your doctor doesn’t want to make that referral, and you go anyway, you may end up paying the entire cost for that care out of pocket. In other words, you give up a some control over heath care choices in return for a smaller out of pocket expense.