Go with HMO or Not?

Go with HMO or Not?

Should you go with an HMO or not when you are searching for a health insurance plan? Perhaps managed care will work for you.

For those that don’t know what an HMO is, it stands for health maintenance organization, a type of managed care organization. An HMO sets out guidelines for their affiliated physicians to work with in terms of care to provide and price structures. Is that a good thing for you? In some respects, it may very well be, but it’s a decision you will need to make, based on your personal preferences.

Generally speaking HMOs have lower monthly fees when compared to other alternatives. In addition, the fees are deducted from a paycheck. Keep in mind that this requires a co-pay or the amount paid during a treatment that is deductible from the overall cost of the medical bill. This isn’t to say the rates are the same for every doctor in an HMO, as this is not the case. Each doctor’s office bills out according to their office hourly rate, what tests they may conduct, or treatments they handle for you at the office; e.g., giving needles, taking blood pressure, examining ears, etc.

Here is the most crucial question you will want to ask though and that is how can an HMO offer less expensive health care? The first way this is possible is because they do business on a volume basis, as in they have millions of people as subscribers. They also deal directly with health insurance companies and thus get a better deal, based on volume.

The second reason HMOs are able to offer better rates is because one of their main focuses deals with preventive health care and to that end they work to inform their clients of ways to better enhance their health. This tends to involve, among other things, proactive communication with patients by using handbooks and health guides.

There are some other points you will need to know about HMOs prior to deciding if they are for you. For instance, you will need to pick a primary care physician because that is compulsory if you opt to be in an HMO. Primary care doctors may be GPs, pediatricians, internists or family doctors, and they are more or less the first person you seek medical care from; call them the gatekeeper of medical services or the first port of call.

The idea here is that this doctor figures out what treatment the patient needs or doesn’t need, and will step up to bat to handle all other health care issues, unless there is a need to send the patient to a specialist. You can’t go directly to a specialist without a referral from your primary care doctor. If you opt to choose something called an open access HMO, then you would be able to go to whomever you choose for doctoring. The costs of an open access HMO is higher when it comes to expenses such as co-payments and co-insurance.

Some cons of choosing an HMO involve the quality of the service provided; the lack of tests offered even though they are called for by the doctor; HMOs that refuse to pay for treatments even if the doctor does recommend them; and how little time the doctor has to spend with patients when they go for an appointment.

What you choose will be what you think works for you. Check out both sides of the debate when it comes to choosing an HMO or not. An informed decision is better than one made without any information.  For questions on an HMO Health Insurance Plan or Medicare Supplement please give us a call at 954-282-6891.

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