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How do I Choose the Best HMO Plan?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 20 September 2016
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Choosing the best HMO plan is always recommended, but not all people have significant choice in this matter. When people receive their health insurance through an employer, they may not have a choice. A single company may be selected as the HMO provider, and some employers won’t even offer an HMO plan. On the other hand, those who do have options may end up with a lot of choices and that can seem overwhelming. There are some simple ways to determine which HMO plan is best, and these include evaluating costs, looking at providers available under the plan, comparing exclusions, and researching plan satisfaction and legitimacy.

Cost will obviously be an important factor for many people choosing an HMO plan. It’s usually true that HMOs are less costly than PPOs because they require people to work with doctors and allied professionals that are part of the health maintenance organization. Limiting people to getting care from member health professionals greatly limits cost, and most people must go through a pre-approval process and require a referral if they want to see a specialist. The different cost factors to consider include total monthly costs for enrollment, cost of copayments, and amount of deductibles.

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A very inexpensive HMO plan can be attractive, but only if it will truly provide the health coverage needed. Since HMOs require people to use organization health professionals, it’s vital to ascertain how many of these are available locally. Don’t simply check for primary care physicians, but also check specialists that might be needed. Does the plan contract with a lot of therapists, physical therapists, cardiologists, pediatric specialists, etc? It’s valuable to look at facilities people can use too, especially hospitals.

Each HMO plan should also be judged by what it excludes. Will a private plan not cover pre-existing conditions for several months? Does the HMO truly provide reasonable coverage, and does it extend to cover things like heart transplants, bone marrow transplants, and surgeries? Be sure to fully understand what types of care won’t be offered before signing up.

Lastly, there are some ways to research plan quality or satisfaction. The US News & World Report, publishes a yearly ranking that is compiled by the National Committee for Quality Assurance, but some small plans might not be featured. If the plan is local, ask around to see if friends or acquaintances use it. Once people have narrowed down their choices to a couple of plans, verify that they are legally operating with the state Insurance Commissioner and the Better Business Bureau. There is insurance fraud of many types, and it’s important not to hand a cent over to a company without making certain that company is credible.

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Discuss this Article

Talentryto
Post 3

@raynbow- I think that you should keep in mind that if the HMO plans that your company is offering are very limited, they might not be worth the cost. If the network of healthcare providers in your area that contract with the HMO plans is very limited, you might actually be better off buying a health insurance plan from an insurance company that has a wider provider network.

Ocelot60
Post 2

@raynbow- I have had to choose HMO plans before, and I hate the process. Choosing the right one can be the difference between not having to pay a lot of out-of-pocket costs and having expensive medical costs that are not covered by the plan.

Speaking from experience, I think that the first thing you need to do before you pick your HMO plan is call all of your healthcare providers to see which plans are in their network. If the plan you choose is not accepted by the doctors and medical facilities you go to, you will have to change providers or pay more out of your own pocket.

When it comes time to finalize your plan, make sure that the human resource department is aware of the plan you want. Then, make sure that you get your HMO plan information packet and your insurance cards so that you will be ready to use your benefits.

Raynbow
Post 1

My employer is offering several HMO plans to choose from, and I find the process very confusing. Talking to the people in the human resource department wasn't much help, either. What are some things I need to consider before I sign up so I can make sure that coverage in my area will fit my needs?

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