HMO - Health Maintenance Organizations

A health maintenance organization (HMO) is a managed care plan. This health care plan is provided by a network of hospitals, doctors, and other health care providers. HMOs are offerec by insurance companies as a popular alternative to traditional health care plans for HMOs ability to cover a vast amount of services at a much lower cost.

What you get

In an HMO you choose a primary physician to act as your contact for about all of your health care needs. You must choose the physician form a list of doctors in the HMO's network. This physician oversees all of your medical care and provides referrals when other specialists are needed. HMOs can control costs this way, and also do so by not covering services that are not considered medically necessary. Also the HMO will specify what drugs doctors can prescribe. HMOs will use its "netowork" of selected doctors and facilities to privide services to the members of HMOs. Members are usually required to go in for regularly schedualed care from the providers in the network. The goal being preventative health care. Atempting catch anything and treat it right away, so as to keep costs down.

What you pay

When you are in an HMO you will pay premiums, copayments, deductibles, and any other expenses the HMO does not cover out of your own pocket.

A premium is a set fee that the member will pay each month, reguadless of how much medical atention was given to the patient in that month. The copayment is the cost of going in to see or recieve medical care. This is the cost of the doctors visit, or the perscirption drugs that are picked up, also any medical procedures (surgeries, X-rays, ext) that are required and covered by the HMO. An HMO sets out what the copayment is for specific things. Also there is deductibles. The deductible is the amount the member must pay out of their own pocket before the HMO will pay for the covered service. For example, in a doctors visit the HMO may require the member to pay $10 for a visit. The HMO will pay everything else after the deductible. So if the visit costs $60, the HMO pays $50. If its $100, they pay $90.

References:

1. http://www.medicarehmo.com
2. http://www.cbsnews.com/stories/2001/05/01/national/main288749.shtml
3. http://www.agencyinfo.net/iv/medical/types/hmo-ppo-pos.htm
4. http://www.tdi.state.tx.us/consumer/cbo69.html

Related Topics:

1. http://www.rand.org/pubs/research_briefs/RB4540/index1.html