HMO Plans (Health Maintenance Organization) are a kind of health insurance that can drastically limit your options for seeking care, but provide a large monetary compensation in return. It all comes down to finding an HMO with a large enough network, and a good enough location for you.
HMO plans operate through a network system. Unlike PPOs, which just change the amount charged based on whether you’re seeing a doctor who’s in their network or not, HMOs do not cover health care if it’s outside of their network. This can pose a problem for people who live far away from major cities, or who develop an acute or rare illness or problem. If there isn’t a specialist inside their HMO network, they’re going to have to pay out of pocket for those appointments and treatments. If someone lives in a rural area, or just far from doctors in their HMO network, it could be a long trip to the doctor every time they have a sore throat or a cough that just won’t go away.
Though the detractors are large, HMOs remain very popular because they offer many benefits to those who have their insurance. Within their network, doctors have agreed to significantly lower costs; this means that the patient is being charged less and their insurance will cover a lot of that as well. This spells big savings for patients. Additionally, most HMOs are rigorous in who they allow into their doctor system. Doctors are held to high quality standards, hospitals are held to high standards, and the insurance holding patient benefits from this screening process. Many people have difficulty finding a doctor they can trust, and don’t know how to investigate their track record. It’s much easier to find the criteria by which an HMO evaluates their doctors and know that every doctor in their network passes these checks.