A Primer on HMO Insurance Plans

Wednesday, October 28th, 2009 at 3:38 pm

Health insurance is such a burden on our budget. We have to pay for it every month or year depending on our plan. When we don’t need to use it, that makes it all the more frustrating since the money we pay goes to waste. On the other hand, if we have an illness that’s too expensive to cure, our health insurance will cover it. That’s the time our annual payment becomes worth it.

But because not everyone will use it in their lifetime, there is now a new option to choose from. Many people complain that they waste a lot of money on health insurance, so to make it cheaper; the HMP health insurance plan was started. This is different in many ways from the traditional health insurance we’re very familiar with.

The HMO or health maintenance organization is a health insurance plan similar to the plan we’re accustomed with. It pays for our medical bills when we go to the doctor or when we need medicine for our illness. However, there’s also a big difference between the two. It’s more affordable but it has its own setbacks.

HMO pays for only a limited number of illnesses. It allows the members to have a primary doctor and hospital who works with the HMO so they will know what sort of prevention to give you. The doctors are connected with the organization into giving you checkups. This way, they will know if you really need treatment. Unlike the traditional plan which makes some people take unnecessary pills, HMO doesn’t have that nonsense. If ever you are ill with something they cannot cover, they can recommend you to something else.

HMO mainly focuses on preventing illnesses, instead of curing it. Also, it doesn’t require you to pay for fees that seem unlikely to happen in the future. For example, it doesn’t cover a disease that comes in one-in-a-million patients, but it probably covers breast and lung cancer, depending on your negotiation.

When you go for a medical service, the doctor and hospital you’re going to should be approved first. Unless they are members of the HMO network, you’ll have to pay for your fees which are pretty expensive. Another thing to know is that when you always go to a doctor, you will have to pay a little something in exchange. You cannot expect to receive all these free unnecessary services anyway.

For me, the advantages and disadvantages of the HMO health insurance plan balances everything out. HMO has the benefit of a lower insurance cost. It also focuses on making preventive measures. They want you to seek out medical services so future expenses can be avoided. This is good for our health, since the chances of our getting sick are slimmer. Another advantage is the unlimited benefit of this lifetime plan. As long as you don’t quit being a member, they will pay for your medical fees.

However, the disadvantages can also be felt. You can only go to the primary care physicians you chose the first time. You can’t seek other help unless it was recommended by your physician and with the approval of the HMO. The problem with this is if your physician doesn’t have the competency of a great doctor. You can find another physician with the approval of the insurance. This could be hard though, and you can only change your doctor probably once or twice in your lifetime. Of course, if you want to seek other opinions, you can but with your own money. The only exception to this is in emergencies. But even with that, your HMO plan has its own definition of an emergency.

Because of the benefits and drawbacks of an HMO plan, you have to analyze carefully which is better for you: the traditional or this option called HMO? What could make this decision easier for you is if you think with these questions in mind. Can you afford to have the regular plan with higher fees and still live comfortably? Is there a chance that I will need the medical needs the HMO plan doesn’t cover? Which is more advantageous to me in the long run?

When you think about the health insurance fees you have to pay, don’t always feel so glum. Just think of how much you will save if your treatment for some disease is covered by the insurance. You don’t have to worry about additional fees unless some complications will occur.

Delicious Digg This Reddit Stumble This