Is it time to switch to an HMO Plan?

by John Hansen

HMO Health Insurance Plans

Health maintenance organization plans, also known as HMOs, are often the most affordable health insurance plans you can buy. HMOs are managed care plans. You receive health care from a network of providers who agree to offer services to members. HMO insurance plans cover the medical services of a group of doctors, specialists, clinics and hospitals.

HMO Insurance Plans Are Affordable

The biggest benefit of HMO insurance plans is their affordability. They feature very low monthly premiums and have lower out-of-pocket care expenses. You won’t pay any annual deductible before coverage, and your co-payments will be minimal. You also won’t have to submit your claims to the insurance provider.

Most HMO plans offer comprehensive health care benefits with coverage including preventative care, specialist care, emergency and hospital care, prescription drugs and outpatient surgeries. Keep in mind, however, that you won’t receive coverage for any health care services rendered out-of-network or for services provided without a referral from your primary care doctor.

An HMO Plan is right for you if:

  • You’re looking for a health plan with smaller premiums and out-of-pocket costs
  • You’re looking for a health plan with no deductible
  • You need certain services, such as coverage for immunizations and check-ups

So, where will people go?

If you visit the doctor for routine check-ups, you’ll usually be required to make a co-payment. With HMO insurance plans, the co-payment can be as low as $10.

Additionally, you won’t be required to submit a claim. As long as you have your HMO insurance card and you have made the co-payment, the rest will be sorted. Avoiding lengthy procedures is one of the most significant benefits of HMO health insurance.

Even though you won’t receive care from a doctor who doesn’t participate in your network, you can rest assured HMO networks usually include thousands of specialists and healthcare professionals. Finding a doctor or hospital isn’t usually a problem.

Choosing a Primary Care Doctor 

With HMO plans, you’ll need to select your primary care doctor (PCD). The doctor will be your go-to physician any time you want to access medical services. They will take care of most of your healthcare needs. If, for any reason, you need to be referred to a specialist, your primary care physician will make the referral. Without the referral from your PCD, your HMO insurance plan won’t cover the services you receive.

Physicians considered primary care doctors include:

  • Family doctors
  • OB/GYN
  • Pediatricians
  • Intern doctors

To avoid paying substantial medical bills, make sure you stick to your HMO primary care doctor. If you go outside the HMO, your insurance plan won’t cover any of your expenses.

Comparing Your HMO Options

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

Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.

Covered California is the Golden State’s official health exchange marketplace where individuals, families and small businesses can find high-quality, low-cost California government health insurance.

Learn about Obamacare income guidelines in California using our income limits chart, and see if you’re eligible for government assistance.

Learn about the Covered California website. Find easy online enrollment. Set up your account, log in, buy insurance and more on the California health marketplace website.