What the heck is an HMO health insurance plan?

January 15, 2016

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A Health Maintenance Organization plan (HMO) means you can only consult with physicians in your HMO network, otherwise you will pay out-of-network expenses (unless it’s an emergency). HMOs are often the most limited type of health insurance plans. When you apply for an HMO, you must select a primary care physician, and you have to get a referral from that primary care physician in order to see a specialist.

In plain English:
An HMO plan means a lot of your doctors may not take your insurance card. It’s important to check if your doctors take HMO plans before you apply. The other bummer is that you need to select your PCP (primary care physician) upon applying AND you have to get a referral from your PCP to go see a specialist (meaning you have to pay for TWO appointments). However, the nice thing about HMO plans is that they often have lower monthly costs because they don’t offer as wide of a doctor network.

HMOs are a great option if you can’t afford expensive monthly payments and don’t plan on going to the doctor a lot. If you do plan on going to the doctor a lot, a PPO, POS or EPO plans might be a better option. If you have any questions, we can help you pick the best plan for you.