Overview of an HMO Health Insurance Plan

The world of health insurance has become a great deal more complicated in recent years, and it can be difficult for workers and self employed individuals to get the coverage they need when they need it. There are many different options available when it comes to health insurance, and it is important to know the advantages and disadvantages of each type of coverage.

One of the most popular types of health insurance coverage is the health maintenance organization, known in the industry as an HMO. Health maintenance organizations work to keep costs low by serving as gatekeepers – assessing the value of each procedure and ensuring that it represents a good use of health care dollars. In most cases the individual’s health care will be coordinated by a primary care physician. This individual will make needed referrals to specialists, provide routine care and keep track of the patient’s progress over time.

The idea behind the HMO is that the savings achieved can be passed on to members in the form of lower premiums. .By keeping costs under control in a variety of ways the health maintenance organization can also provide small companies and large corporations alike with cost savings they can use to enhance coverage for their workers without sacrificing the bottom line.

When considering an HMO it is important for individuals to take a look at the coverage they provide and ensure that the coverage they provide will be sufficient. For instance, it is important for the individual to look at the list of participating physicians and ensure that their personal doctor participates. Many people are understandably reluctant to change doctors; making sure a particular physician participates can make choosing an HMO a lot easier.

It is also important for individuals to understand the procedure for getting a referral, seeing a specialist and getting additional care. Many HMOs require all care to be coordinated through the primary care doctor, and not following the established rules could result in denied claims and significant out of pocket costs.