With an HMO, your specialist gets a good picture of your overall health and keeps track of results from different specialists. It’s an integrated care model that focuses on keeping you healthy. When you need to see a specialist, your primary care doctor will refer you to one who’s part of the HMO’s network. By seeing only in-network providers, you’ll pay lower medical costs and you won’t have any unexpected bills showing up in the mail. Specialists and services that may be included in your HMO network include:
ClinicsHealth care professionalsHospitalsImaging centersLabsMedical equipment vendorsPharmacies
However, if you go to an out-of-network health care provider, your HMO typically won’t cover any of the costs. This is because in-network providers have agreed to charge certain prices for services. Out-of-network providers may charge more.
Example of an HMO
For example, if you’re experiencing debilitating headaches, you’d need to see your primary care doctor first. If your doctor thinks you need additional testing, they might refer you to an in-network neurologist. If you called a neurologist directly for an appointment without a referral, your insurance likely wouldn’t pay for your visit.
HMO vs. PPO
For example, with a PPO, you don’t have to select a primary care doctor. This means if you need to see a specialist, you can contact one directly and schedule an appointment. You can also visit doctors outside of your network if you have a PPO. This means if you’re traveling and get sick, you can visit any doctor. If you want to save money on monthly health insurance costs, an HMO is typically less expensive than a PPO. However, a PPO offers greater flexibility since you can choose from more options when you need care.
Is an HMO Right for You?
You want to make sure your health insurance is a good fit for you and your lifestyle. An HMO might be right for you if:
You’re concerned about monthly costs and want to save money on health insurance. You don’t mind partnering with a primary care doctor for your health decisions. You typically stay in your local area, where you can be treated by in-network providers.
However, if you want more flexibility to see doctors outside of the approved network or without a referral, an HMO might not be the best choice for you.
