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Advantages and Disadvantages of HMOs

Posted in HMO , Health Insurance

September 28th, 2009
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If the health insurance coverage you’ve been thinking of purchasing is with an HMO, you may want to first consider the advantages and disadvantages.

By exploring just what the pros and cons are of taking on this type of coverage, you can make sure youre making the right choice before signing on the dotted line.

Advantages of an HMO

Disadvantages of an HMO

Now that you know some advantages and disadvantages of the HMO, you can make a more informed decision on the type of health insurance coverage youd prefer. So what are you waiting for? The time is now to get insured!

HMOs for the Self-Employed

Posted in HMO , Health Insurance

September 25th, 2009
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There are many HMOs available to people who are taking the working world on their own.

They can be pretty reasonably priced, too. So if you want to become self-employed and are worried about coverage, lets look at what options are out there for you.

What are HMOs?

HMOs are also known as health maintenance organizations. Under this type of coverage, you can only see doctors that are members of the HMO.

When you sign up, you select a primary physician who will then coordinate all of your medical care. This means, if you need to see a specialist, your primary physician will refer you to that person. The only aspects of this type of plan that are exempt from the referral are visiting the OB/GYN or going to the emergency room.

What’s Better About HMOs?

What people like about HMOs is that they are typically a bit cheaper than PPOs and POSs and have no deductible, even though you do have to make a co-pay with every doctor visit. The co-pay isnt too bad, however; it falls in the ballpark of $5 to $20 depending on what your monthly premium is.

How to Obtain Health Insurance for Self-Employed

Signing up for HMOs if you’re self-employed is just a matter of finding a company that offers the coverage.

However, it’s good to make sure that there are primary care physicians in your area that work with this type of coverage. For those in big cities, this is usually not a problem. But if you live in a smaller community, you may have a more difficult time getting this type of health insurance for self-employed.

So do you think working under HMOs will suit your needs? If not, there are plenty of other types of health insurance for self-employed to explore.

HMO: Copayments

Posted in HMO , Health Insurance

September 23rd, 2009
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Those seeking low cost and high quality health insurance may benefit from becoming a member of a health maintenance organization (HMO). HMOs are a type of managed health care provider where the goals include preventative medical care, providing affordable medical coverage as well as helping an individual maintain their health and provide sufficient care in the case ofillness or injury. HMOs are able to provide affordable, quality health care as they have a network of doctors and hospitals under contract and are able to better manage the expenses that way.

Monthly Premiums

When you become a member of an HMO, you will be required to pay a monthly premium to maintain access to the service network system. This premium fee typically covers all the expenses that may be required and no additional money should be required for in-network referrals, surgeries, tests, hospitalization and other specialized care. However, members may incur some minor additional expenses in the form of a copayment, which will be required for in-office visits.

Copayment Basics

Copayments are typically required for HMO doctor visits, so patients are encouraged to take fiscal responsibility for their own care. Many times HMO copayments act as a type of deterrent for those who feel like going to their doctor for every little thing, even those things like common colds. That little bit of money may deter them from wasting both their time and the valuable time of the primary care physician.Copayments are also a nominal way for an HMO to get another revenue stream out of their members. That money can be used to offset the administrative costs that are associated with properly maintaining a medical facility and keeping their records up to date.

Depending on the level of coverage you select through your HMO, you may have no copayment due upon visiting a doctor or you may experience a small charge between $10-$25. Whatever it is, it is well worth the expense to ensure that you are in peak physical condition at all times.

FAQ: How Do Referrals Work in an HMO?

Posted in HMO , Health Insurance

September 23rd, 2009
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Health maintenance organizations are a type of managed care health insurance provider. By joining an HMO, a member can benefit from quality medical attention focusing on preventative care at an affordable rate. When you opt to join an HMO, one of the first decisions you need to make is selecting a primary care physician. This physician will be your main point of contact and if you need any type of specialized care, you will need to see them first to get a referral.

Getting a Referral

As the gatekeeper of the HMO network, the primary care physician is responsible for overseeing the well-being of their patients as a whole, and are in charge referrals. Without a referral from a primary care physician, you will have to pay all expenses out of pocket if you decide to visit a specialist on your own, even if they are in your network.

Specialist Access

HMOs tend to have a full range of specialist who are all contracted by the insurance provider. By seeking the referral from your primary care physician within an HMO, you should be able to get access to and assortment of healthprofessionals, doctors, hospitals, mental health care workers, and other specialists. As the gatekeeper to the HMO service network, primary care physicians will give you the necessary referral if you need a specialist.

Although some people prefer flexibility in their health care plans, many like the one-stop-shopping that an HMO can provide them. An HMO that is properly set up can be a great service network for those who are new in town and are looking for all their doctors in one convenient location. Additionally, within the HMO referral system, communication is better between doctors handling your case due to advances in information sharing between in-network physicians.

How am I billed in an HMO Plan?

Posted in HMO , Health Insurance

September 18th, 2009
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If you are looking for the most affordable type of health insurance that will also provide excellent levels of medical care, then an HMO (Health Maintenance Organization) may be for you.

What is an HMO

An HMO is a type of managed health care plan that provides their members a service network of doctors and hospitals to choose from. The medical facilitators who participate in an HMO are under a contractual agreement to provide medical attention to the HMO members.

How are costs different for HMOs?

Because there is such a regimented service network system in place, the insurance company has more control over the costs and bottom line of the medical care provided. This allows for the overall costs for HMO membership to be the least expensive type of medical insurance. Within an HMO there are different price points for coverage a member can choose from and that makes billing in an HMO plan fluctuate a bit.

How do HMOs bill?

A member of an HMO is billed monthly for their premium. That premium must be paid on time to be considered an active member of the plan. Depending on the insurance level the person opted into, a member may or may not have to pay a co-payment to see a doctors appointment. If the doctor orders specific tests such as blood work or a brain scan, a member will not have to make any out of pocket payments as the additional treatment is included in their treatment plan.

The medical treatment provided by HMOs is on a prepaid basis, thus members are only billed for a fixed monthly rate (premium). Regardless of how much medical attention is needed at any given time, the HMO will cover the costs. The premium entitles the member to take advantage of preventive medicine, office visits, hospitalization and surgery.

HMO Basic Facts

Posted in HMO , Health Insurance

September 3rd, 2009
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If working with an HMO is your preference for health insurance, you may want to check out some basic facts about it before applying for coverage. This way, you won’t feel obligated to take on coverage that you dont think youll truly benefit from.

What is an HMO?

HMO stands for Health Maintenance Organization. It offers comprehensive coverage, which includes doctor’s visits, surgery, emergency care, hospital stays, x-rays, therapy and more.

HMOs were created as a way to provide preventative treatment. As a result, patients are able to take advantage of immunizations, mammograms and physicals.

What are the benefits of an HMO?

This type of coverage comes at a lower monthly cost than other types of health insurance. If you go with an HMO, you have to work with one primary care physician who will be responsible for assigning all other care givers to you. The only exception to this rule is the emergency room visit, or going to the OB/GYN.

How much do HMOs cost?

Your co-payments are usually lower than with the PPO or POS somewhere in the ballpark of $5 for primary care visits, $15 for specialist visits, and $25 for emergency room visits. No deductibles are required.

What are the drawbacks of HMOs?

This type of health insurance may not be available everywhere. If you live in a remote area, there may be few or no physicians that work with an HMO. While the coverage is considered comprehensive, there are some services that may not be covered. These are determined by individual HMOs.

Judging by the list of facts above, there are both pros and cons to joining an HMO. So if you’re not sure this type of health insurance coverage is right for you, theres no harm in looking at the PPO or POS to see if they more closely match your needs.

HMO Restrictions

Posted in HMO , Health Insurance

August 26th, 2009
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Medical insurance is a necessity that can help improve not only the quality of life for the insured, but protect their financial resources as well. With medical insurance in place, individuals are more prone to see doctors regularly for preventative care as well as not putting off seeking medical attention when they need it. Additionally, health care insurance can provide an important financial cushion for those who need to really take advantage of the medical system. With medical insurance, financial ruin due to medical expenses can be avoided.

For those who are seeking an affordable yet good quality level of medical insurance, a Health Maintenance Organization (HMO) might do the trick. Under an HMO, there is a service network system compromised of participating doctors and hospitals.From the insurance company’s perspective, they can more easily control the costs of medical care that their patients seek, thus making the overall cost to be covered by an HMO plan lesser then other insurance options.

HMOs Offer Little Freedom

Aside from being affordable, HMOs are also known for being the most type of restrictive health insurance. Some HMO restrictions are:

• Members of an HMO must choose a primary care physician (PCP) who then becomes the main point of contact for any other services offered through the health network
• If a patient is interested in seeing a specialist within an HMO system, they must first get a referral from their primary care physician
• Except for emergency care, members of an HMO are expected to seek all their medical attention from within the network and no compensation will be made to offset the cost of out of network health care

If however, you feel like you can work within the restrictive nature of the HMO health care system, then you can benefit from the care they provide. Some HMOs have large buildings with almost every level of medical care on site, thus making it easy to get a blood test, physical and appropriate medication in one day. Most importantly, HMOs are extremely focused on preventative medicine as it will help ensure the health of the patient while lowering the overall cost the insurance provider will have to pay out of pocket.

Advantages and Disadvantages of Managed Care Insurance

Posted in HMO , Health Insurance , Managed Care Insurance , PPO , Point of Service Plans

July 21st, 2009
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Managed health care is the predominant form of health care in the United States. Those of us who are lucky enough to have health insurance, whether we get it from our employers as a benefit, or if we pay for it out of our own pocket, will more than likely be getting it from a managed health care insurance provider. These providers, whether they are health maintenance organizations (HMOs), preferred provider organizations (PPOs), or point-of-service plans (POS), all come with their various pros and cons. Read on to learn more about the advantages and disadvantages of managed care insurance plans.

One of the advantages to being a member of a managed health care insurance program is the depth and breadth of your choices. If a PPO or HMO system, for example, is large enough, you could have your pick of some very talented doctors and renowned medical facilities. The coverage of your managed care network will be influenced by where you live. Members of a POS or other managed health care systems who live in Atlanta, for example, will be in a bigger network of medical professionals than those living in rural, sparsely populated northern Maine.

Additionally, managed health care insurance organizations create large groups of members, like yourself, which in turn lowers costs for everyone.

In terms of disadvantages, many people in managed care insurance programs complain about their lack of choice – even if they live in a large metropolitan area that has many excellent doctors in it. People who get their health care from managed care insurance programs also don’t like the rigidity of the process, and can easily feel like numbers being pushed through a big, complicated, and unfriendly system – especially if they have a condition which is going to cost the managed care insurance provider a lot of money.

To learn more about the advantages and disadvantages of managed care insurance, be sure to consult with a managed care insurance professional. If you get health insurance from your employer, you can also go over the details of your HMO, PPO, or POS plan with a member of your human resources department.

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How Do I Get Managed Care Insurance?

Posted in HMO , Health Insurance , PPO , Point of Service Plans

July 15th, 2009
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Many people get their managed care health insurance from their employers. Employers are now seen as the logical source of health insurance in the United States. In other countries, the government is seen as the logical source of managed health care, and so companies play no role in their employees’ health care. This allows them to be more competitive in the world economy because they are freed from a staggering financial burden. Here in the United States, however, people will seek out companies that offer the best health care benefits as a good reason to work for a certain employer.

For people who pay for their own health care needs out of their own pocket, they are very often drawn to managed health care programs, whether they are HMOs, PPOs or POS, because the costs are fairly reasonable.

Managed care insurance can be found by contacting a health insurance specialist, or doing research on the Internet. Managed health care is readily available for just about anyone who can afford it. The only people who will encounter problems are people with expensive preexisting conditions that health insurers will not want to take a risk on.

One of the most fundamental axioms of life is that it is filled with risks and dangers. Just about anything could happen to us, and at any time. By and large most of us recognize that fact and move on to enjoy life to the fullest. However sane that perspective may be, it does not mean to ignore risks and dangers and not prepare for them to the best of our abilities, and within reason. One risk that can be addressed reasonably, before it materializes, concerns the state of our health. We take care of the risks associated with our health by getting health insurance. Of all the kinds of health insurance options available, managed care health insurance is the most prevalent and widespread.

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HMOs vs. POS Plans

Posted in HMO , Health Insurance , Point of Service Plans

July 13th, 2009
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Choosing a health insurance plan can be an intimidating process, especially because of all the abbreviations used to distinguish the different type of policy options. POS plans and HMOs are not an alphabetical collision, they are types of health insurance plans consumers can choose from either through self-insurance or more typically through their employer’s benefit plans.

HMOs are a “health maintenance organization,” that is, a type of managed-care health provider system. HMOs tend to focus their energies on preventative care and utilization management controls as a way to reduce the overall costs of health care both for themselves and their member groups. By opting into an HMO plan, an individual is immediately provided a community of doctors, hospitals and insurers that work together as a team and through this network, members are provided with one-stop shopping foroffice visits, hospitalization and surgery.

The Pros of HMOs

• Low out of pocket costs for premiums, appointments and treatment
• Preventative care like annual check ups, mammograms, prostate checks, blood pressure and the like are top priority
• There are typically no lifetime limits or caps restricting the amount of medical expenses the insurance will pay for

The Cons of HMOs

• Doctor visits outside the HMO service are not typically covered
• There are restrictive policies and procedures that may limit the type of specialized care an individual may receive

POS stands for “point-of-service” plans. These types of plans tend to be more a bit more flexible towards allowing the policyholders to seek out doctors of their choosing. POS plans offer a service network plan like HMOs do, and can additionally offset the costs if you choose to utilize a specialist or doctor outside of the primary care network. When you choose physicians and care within the POS network, most of the costs will be absorbed or will be minimal, very much like an HMO. However, when you choose to seek advice of doctors not within the network you will more than likely have to meet a deductible amount and be responsible for a portion of the doctor’s bill.

The Pros of POS Plans

• They provide flexibility to choose doctors that are out of network without having to go through the system
• Treatment within network require no deductible and low co-payments
• Out-of pocket costs are capped leaving more money in your pocket
• Customers get the benefits of both their network and freedom of choice

The Cons of POS Plans

• Co-payments for out of network care can be costly and range anywhere from 30%-40% of the billing amount
• Deductibles must be met before the benefits kick in
• You must navigate the HMO system to get specialist referrals

For more information on HMOs, POS plans, and other health care plans, please visit Go Insurance Rates for more research and information.