Health Maintenance Organization (HMO) plans give you an affordable health insurance option but do not give you the flexibility that other health insurance policies offer.
HMO policies provide you with a network in which you must choose your primary care physician — usually an internist, doctor, or pediatrician. If you need a specialist you must first go to your primary care physician who will then refer you to someone else. Once referred, this specialist will be considered as part of your network and you will not have to pay out of your pocket to see them.
HMO plans provide comprehensive coverage in the fact that they include prescriptions, hospital stays, outpatient surgeries, emergency care, routine checkups and preventive care. To stay covered under a Health Maintenance Organization plan, you have to pay a monthly fee, known as a premium.
Also when you visit your primary care physician for basic care, you will have to pay a co-payment with most HMO health insurance policies. These costs are usually very low ranging from $5 to $20. The cost of prescriptions will also be very low.
The problem with HMO plans is that if you need to see a doctor out of your network and you do not receive a referral from your doctor, then you will have to pay for the medical care without any help from your insurance company. Unless it is a medical emergency, you will be paying for the health care services by yourself.
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