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In a nutshell, Health Maintenance Organizations (called “HMOs”) are usually the most affordable way to get coverage for your medical needs. The trade-off is that HMOs offer you less freedom of choice than do other types of insurance.
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How HMO Plans Compare
- Most Affordable Full Coverage
- Reduced Freedom
Texas has some of the most comprehensive patient protection laws in the nation. HMO regulations, for example, require that the provider have adequate personnel and facilities and make sure that healthcare services are within a certain mileage of your home or workplace. This means you can feel confident when you select an HMO that the provider will live up to its promises. That’s a good feeling.
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Important Points About HMO Plans
- In order to keep costs down, the plan uses an approved network of doctors and other healthcare providers (hospitals, specialists, etc.). As a member, you are generally required to use only this network for your health care. There is an exception is if you need emergency care outside of the network area.
- You choose a primary care doctor from the network. This person acts like a traditional family doctor to oversee your care.
- If you need specialty care, you must get a referral from your primary care doctor.
- If you see a doctor or specialist outside the HMO network, you will be responsible for all of the costs.
- Most HMOs cover preventive care, such as routine physicals, immunizations and health screenings. The idea is to keep you, the member, healthy rather than just treat you if you get ill.
- Most HMOs require little or no paperwork on your part. Unlike fee-for-service plans, HMOs don’t require you to file claim forms.
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Different Types of HMO Plans
- Copay Plans – These work well for people who make regular doctor’s visits, such as families with young children. You pay a small fee (about $10-$50) for each visit.
- Deductible Plans – These usually work best for people who don’t often need to seek a doctor’s care. Insurance coverage starts after you have paid a certain deductible each year.
For details on which HMO plans are offered in your area, please see the Texas-Health-Plans Providers List.
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