The health care industry is one that is wrought with acronyms. Sometimes, these labels can be confusing to people who are just looking for the right health care policy for themselves or their families. By educating yourself on the meanings behind some of the more prevalent acronyms, you can greatly reduce the stress involved with selecting the right insurance plan.
HMO stands for Health Maintenance Organization. Under this type of plan, patients must choose a Primary Care Physician (PCP) and will only be covered for procedures if the doctor or hospital is part of the HMO network. Under an HMO, most patients will need a referral from their PCP before being able to see a specialist. The purpose of these restrictions is to provide reliable care to patients and a steady stream of businesses to healthcare providers.
Advantages of an HMO
The advantages of an HMO are largely a matter of opinion and personal taste. There are several characteristics of an HMO that can be advantageous for those who prefer a certain type of coverage. While HMOs can be somewhat more restrictive than other options, they can also be exactly what an individual or family is looking for.
The characteristics of an HMO that are typically viewed as advantageous may include, but are not limited to:
- Having the same primary care doctor with whom all interactions begin
- Predictable regular fees
- No need to fill out claims forms
- Typically lower premiums
Disadvantages of an HMO
While HMOs might be perfect for some people, others may view HMOs as too restrictive. These types of people might wish to have more freedom in regards to their healthcare, rather than being tied down to one specific set of providers.
The characteristics of an HMO that may be viewed as disadvantageous can include:
- A requirement to remain inside a predetermined network
- A requirement to see a PCP before any other healthcare procedures
- A requirement for a referral from a PCP
- An ability to only visit certain hospitals to be covered
Speak with a Professional
In the end, it is difficult to say if an HMO is the right plan for a given individual or family. It depends upon their resources, general health and healthcare requirements, and type of coverage desired. If you have questions about your specific case, call or visit The Blue Store and speak with any one of the highly qualified agents. He or she will be able to answer any specific questions you might have regarding the efficacy of an HMO plan for healthcare coverage.