Health Maintenance Organization (HMO)
There are several types of personal medical insurance. Group HMOs, group PPOs, EPOs, and POS plans are the main options for most Americans.
Group HMOs are an affordable option offered through group insurance plans which covers hospital stays and most medical expenses, but they don’t cover all types of care.
What is a Group HMO?
The CDC defines a group HMO (health maintenance organization) as:
an HMO that contracts with a single multi-specialty medical group to provide care to the HMO’s membership. The group practice may work exclusively with the HMO, or it may provide services to non-HMO patients as well.
An HMO is a group health insurance plan that requires you to use doctors and hospitals in the insurer’s network.
This type of plan may be cheaper than other options because it limits your choice of providers, but it can also create challenges if you need care outside that network.
What Does a Group HMO Cover?
A group HMO includes hospital and medical coverage and some preventative care such as physicals and routine health screenings.
All of these services are limited to in-network facilities and providers.
The coverage includes access to doctors, hospitals, lab tests, imaging studies, etc., so long as they are done in-network.
What Does a Group HMO NOT Cover?
Group HMOs don’t cover out-of-network providers or facilities, and you’ll pay more out of pocket if you need to see a doctor who isn’t part of the HMO’s network.
When you have an HMO, your health insurance plan requires that you choose a primary care physician (PCP) who can provide all but the most specialized care. This can be either a doctor or a nurse practitioner.
What are the Limitations?
Group HMOs are a good way to cover your insurance needs, but there are some limitations.
First, you’ll need to make sure you see your PCP for all referrals to specialists and specialized care, or it may not be covered. You’ll also need to make sure all the care you receive is in-network, or you may be on the hook for the full cost of care, procedures, medications, and more.
Depending on what kind of HMO plan it is—and how much it costs—you may have different options regarding specialists or treatments outside of traditional medical practices.
A group HMO is a good option if you’re looking for a way to provide health coverage for yourself or your family.
These plans are affordable and easy to set up, but they do have some limitations. It’s important that you understand these to make an informed decision about which type of insurance plan works best for your needs.