How Do HMO Plans Work?
Members of HMO plans choose a primary care physician (PCP) that is in the plan’s network of providers. The PCP manages and coordinates the heath care of the member, and provides basic preventive care services such as routine wellness checkups, immunizations and physical exams. HMOs offer preventive care for patients at no or a low copayment.If a health care problem arises that is beyond the PCP’s scope of knowledge, the PCP would refer the member to a specialist. The specialist will then treat the member for any illnesses or ailments. The exception is an emergency, when a member would seek out care on their own if a critical situation arises.
Coverage through an HMO is restricted to physicians and services that are in the plan’s network. When a plan member decides to seek services outside of the plan network, they would not be covered, and would pay the full amount of the service from their own pocket. Additionally, HMOs allow patients to see a specialist only when they’ve received a referral from their PCP. Seeing a specialist for a non-emergency without a referral would be the equivalent of going out of network, and the member would have to pay the full amount of the visit.
Why Choose an HMO?
HMO plans are the least expensive of all the managed care plans. Premiums are low when compared to other plans such as a POS or PPO. This would allow employers to pick up a greater cost of the premium, while letting employees pay a lesser portion of the premium. For employees that don’t need to see specialists often, the savings is well worth it. A health plan that’s low in cost can help lead to greater employee benefits satisfaction for staff.With premium costs rising at a significant rate every year, sometimes as much as double digits, curbing health care costs is important for the bottom line. Rather than give up health care coverage for employees, a basic HMO plan can act as a substitute for companies struggling with cost issues with other managed care plans.