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All About HMOs

An HMO, or Health Management Organization, seeks to offer the best price to its customers by forming contracts with service providers. The providers extend discounts to the HMOs, and in return, the clients of the HMOs guarantee the providers a certain amount of business.

HMOs are, for their customers, fairly simple when compared with traditional individual insurance plans. Customers pay a certain premium every month which guarantees coverage. These premiums are generally lower than in fee-for-service plans. Clients are asked to choose a primary care physician- usually a general practitioner or family doctor- who will be their point of contact with the medical world.

If specialists are required, clients must get a referral from this doctor. Once they have chosen their PCP, and assuming their premiums are paid, clients may seek out medical treatment for only a small co-pay per visit - generally twenty to thirty dollars, depending on the specifics of their plan. While this is a more cost-effective system for many, and certainly less complicated than filling out claims forms, as in other types of insurance, it can be limiting- coverage for 'out of network' doctors is not extended except in case of medical emergency.

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