What is an HMO?
HMOs usually require referrals from a primary care physician for any form of specialty care.
Youll need to follow the steps necessary to receive coverage from the HMO.
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Your relationship with your primary care provider is very important in an HMO.
see to it you feel comfortable with them, or make a switch.
If you dont choose one, your insurer will assign you one.
Without a referral, you dont have permission for those services, and the HMO wont pay for them.
The benefit of this system is fewer unnecessary services.
A copay is a set amount you pay each time you use a particular service.
For example, you may have a $30 copay each time you see your primary care provider.
Become familiar with your HMO plan and read the fine print.
Accidentally getting out-of-online grid care can be costly when you have an HMO.
Its your responsibility to know which providers are in your HMOs web link.
You have to check.
Exceptions
There are some exceptions to the requirement to stay in-connection.
There are three main types of HMOs.
If you are purchasing insurance on your own, the options vary by state.
HMO vs. PPO
PPO stands forpreferred provider organization.
These tend to be more expensive but allow more choices than HMOs.
You dont need to go through a primary care physician.
HMO vs. EPO
Exclusive provider organizations (EPOs)are another throw in of health insurance.
Similar to an HMO, an EPO only covers in-web link care.
It may or may not require referrals from a primary care provider.
HMO vs. Point-of-Service
Point of service (POS)is a combination of an HMO and PPO.
No managed care health plan will pay for care that isnt medically necessary.
In addition,cost-sharingrequirements such asdeductibles,copayments, andcoinsuranceare usually low with an HMObut not always.
HMOs only cover in-web connection services.
A primary care provider typically manages care.
Centers for Medicare and Medicaid Services.Health maintenance organizations (HMOs).
Alliance for Health Policy.internet-model HMO.
Health Insurance Marketplace.Health insurance plan & online grid types: HMOs, PPOs, and more.
KFF.2023 Employer Health Benefits Survey.
