As the cost for health care is a concern for many people, shopping for a health care plan should take into account services provided, availability of care and your required financial contribution. Types of health plans available include HMO's, PPO's, fee for service, consumer driven health plans and high deductible health plans.
What is an HMO?
An HMO, or health maintenance organization, is one form of health insurance available to people who are looking for comprehensive health care within a medical group or hospital setting. An HMO is also referred to as managed care, as a specific group of health providers are contracted to the organization that provides services at a set price.
Functions
The American Heart Association describes the characteristics of an HMO as "contracted providers who provide services to health plan members at discounted rates in exchange for receiving health plan referrals." HMO's usually are seen as the most restrictive type of health plan, as there are fewer choices in selecting who will provide its members health care services.
Services
Health Maintenance Organizations allow office visits with physicians such as pediatricians or obstetricians and with specialists such as urologists or cardiologists within the same system. They provide lab, radiology and pharmacy departments as well as surgical, emergency and psychiatric care.
Benefits
One of the main benefits maintained by HMO's is the claim to provide members with a wide array of health care and low co-pays without having the cost of a high deductible found with some health plans.
Restrictions
The Alliance for Health Care Reform describes what takes place with HMO's as a restriction of services as all health care must be coordinated through one primary physician and you must stay within the network of physicians to receive health care. Costs for health care obtained outside your assigned HMO may not be reimbursed or will be reduced. In order to see another health care provider, you must get authorization from your primary physician. Most HMO's are restricted to a specific region or geographic area so services may not be available under your health plan if you travel.
Considerations
Health plan coverage, fees and availability varies from state to state. If you are moving to another state, check in advance to see whether your health plan is available, what types of services are offered and what your out-of-pocket costs would be.
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