Is it time to switch to an HMO Plan?

Posted: September 29, 2022

If you’re burdened with high health insurance premiums and increasing out-of-pocket costs, a health maintenance organization (HMO) plan might be right for you. HMOs are managed care plans that are also often the most affordable health insurance plans you can find. HMOs usually have their own network of doctors, specialists, clinics and hospitals, which allows them to negotiate a certain level of payments for the services their network provides.

What to Know About HMO Plans

HMO plans are a fantastic option for many California residents, but there are many factors to consider when determining if an HMO is right for you. Two primary factors that distinguish an HMO plan include:

Cost: Providers in an HMO network operate from agreed-upon rates, so they often provide lower monthly premiums than other insurance plans.
Choice: When you join an HMO, you need to choose a primary care provider (PCP) from the HMO’s network. This PCP would essentially be your first contact for all non-emergency care.

HMOs are a great choice for those that don’t have specialized health care needs. If you find that you only really need annual health exams and immunizations, an HMO plan could help keep your monthly premiums low.

HMO vs. PPO

HMO plans are just one form of health coverage. Another type of coverage, a preferred provider organization (PPO), is a more flexible type of health insurance that makes it easier to see the provider you want. If you have a longstanding relationship with your PCP and don’t want to forgo using them despite them being out-of-network, you can still see them and maintain some coverage if you have a PPO.

However, PPOs are more expensive than HMO plans. Because the main benefits of an HMO are lower monthly premiums and out-of-pocket costs, this plan is often a better choice over PPO plans.

Choosing a Primary Care Doctor

When you sign up for an HMO, you need to choose your own PCP from the available providers in the HMO network. While this may sound like a limiting choice, HMO networks usually include thousands of specialists and health care professionals, so finding the right PCP shouldn’t be a problem.

Examples of physicians that can be your PCP include:

Family doctors
OB/GYNs
Pediatricians
Intern doctors

Sticking to your covered HMO PCP will help keep your costs low. If you see a provider outside your network, your plan won’t cover your expenses.

Benefits of HMO Health Insurance Plans

If you’re switching to an HMO plan, you will enjoy the following benefits:

Affordability: HMO insurance plans are affordable, with lower monthly premiums, out-of-pocket expenses and prescription costs.
Fewer claims: Since your PCP and other specialist care will usually be in-network, you can file fewer claims.
Convenience: Having a PCP can be more convenient because you can establish a relationship with them. They will be the ones to coordinate and manage your care, freeing you from the stressful process of finding the specialists and facilities you need.
Emergency coverage: Even though you have to use your PCP to be covered for most medical expenses, an HMO will still cover out-of-network care in the event of an emergency.

Comparing Your HMO Options

Want to compare HMO plans for California health insurance side by side? You can get free instant health insurance quotes with Health for California’s online services. You’ll be able to see how California HMO plans compete against each other and find an affordable plan that suits you and your family’s needs. Just take a few seconds to fill out our confidential form. It’s 100% free, and you are under no obligation to buy.

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