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...More Info About HMOs
A Health Maintenance Organization (HMO) is a managed care plan that offers its health insurance at affordable costs through contracted doctors, hospitals, or other healthcare providers. The HMOs refer patients to healthcare providers in return for discounted care costs.
To stay covered by the plan, patients have to receive care from healthcare providers only within the HMO “network”. Some patients find this too restrictive, but that’s why HMOs can offer patients lower premiums and cheaper or no deductibles. And for most people, being limited to the HMO’s network isn’t a problem.
Functions Of An HMO
In addition to lowering costs for the patient, HMOs try to monitor healthcare more closely. They review medical situations — a process called utilization review — to see if a patient may not be receiving sufficient care. The review also monitors unusually high or low amounts of medical services that are being given by participating health care providers.
The main goal of an HMO is to keep the patient healthy so they don’t need extensive medical care. To help ensure patient health, many HMO plans will offer preventive care such as:
- Immunizations
- Mammograms
- Physicals
- Well-baby checkups
In the past, many insurance plans did not offer coverage for preventive care. But today, most HMOs provide them at a low cost or even for free.
While preventive care is important for an HMO, some forms of care like outpatient mental health care or other more costly treatments and diagnoses aren’t covered. And elective services that are not medically necessary — like plastic surgery — are very rarely covered.
Case Management
In specific cases in which a patient has a chronic disease — such as diabetes, asthma, or other qualifying medical ailments — more involved care will be offered. The HMO will provide a case manager to oversee that they are receiving adequate medical care.
Comparing HMOs With PPOs
An HMO is like a PPO, or Preferred Provider Organization — both are managed care plans that offer affordable insurance. However, the HMO only allows coverage with particular healthcare providers, whereas a PPO will offer some coverage with healthcare providers outside of the “preferred” group. If a patient seeks care outside of their HMO network of health providers, they won’t be covered.
Now that you know more about HMOs, get free online quotes to find the right plan for you. Our professional agents will help you explore Blue Cross Blue Shield HMO plans, compare prices, and make an educated decision.
