HMO Health Insurance: Pros and Cons of Choosing This Type of Plan



Health maintenance organizations also known as HMO’s are a type of health insurance that many people choose to take care of their health insurance needs. There are pros and cons to choosing an HMO health insurance program.

HMO’s Offer a Network of Providers

One of the benefits to choosing an HMO for health coverage is the available physicians that the HMO can recommend to offer members medical assistance. These services are available at a discounted price. Those that choose this type of health coverage have access to the highest amount of benefits. Often traditional health insurance requires a deductible to be paid before they will begin to cover medical costs this is not the case with an HMO, a small co-payment is billed instead. The terms of an HMO can make this option affordable for many subscribers.

Preexisting Conditions

Traditional insurance coverage does not allow for a preexisting condition; however HMO health insurance programs do not deny coverage for these medical conditions. Members are given a list of co-pays for the medical services that the HMO covers and coverage many times is 100% after the co-pay has been met. Often an HMO does not have an annual or lifetime cap for coverage allowing for better patient care.

HMO’s Have Limitations

Several cons to choosing an HMO health insurance program is that members are limited to doctors that are on the HMO’s list. The program has negotiated with physicians to pre-pay medical expenses in return receiving reduced pricing. In addition if a specialist is required they must be part of the HMO’s network, hospitals also need to be a part of the program. Referrals are required from the member’s primary care physician. Those that have rare or uncommon medical conditions may struggle to receive coverage for their medical needs. Prescriptions are limited under an HMO program; the plan may cover certain prescriptions by charging higher co-pay that can add up for members.




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