Health
Maintenance Organizations
An HMO (Health
Maintenance Organization) is considered to be a
managed health care plan. The insured chooses a
Primary Care Physician (PCP) from within a network of
doctors, who is responsible for coordinating health
care for each patient. If a specialist is needed, the
PCP must provide a referral for the insured.
An HMO is a
restrictive plan as an insured is often limited to
doctors within a specific geographic area and medical
services must be deemed necessary by the PCP in order
to be covered by the insurance plan.
The advantages
to an HMO:
- Less
expensive than traditional medical insurance
- Preventive
care is covered
- There
are no deductibles
- Emergency
medical care does not require a referral
- No
claim forms are required
The
disadvantages:
- Restrictive
in choice of doctors
- Specialists
visits will not be covered without a referral from
the Primary Doctor
- PCPs
may be restricted in the types of tests they can
order for patients
By Eileen Bailey
See
also:
Understanding
Health Insurance
Major Medical
Health Insurance
PPO (Preferred
Provider Organization)
POS (Point of
Service Health Plan)
Health Insurance
Terminology
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