Tips for Finding HMO Health Insurance

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Tips for Finding HMO Health Insurance

Tips for Finding HMO Health Insurance

So you know that you want to choose an HMO plan in order to keep your costs down, but now what? What else do you need to think about before joining one of these plans? There are many things that you should consider before deciding on any health insurance plan, but an HMO has some special considerations. Below are 6 things that you should consider when choosing your HMO plan.

  1. Find out if your doctor and hospital of choice are in your network before purchasing an HMO plan. This is important because HMOs are very restrictive and you will have to find a new in-network doctor or pay out-of-pocket to see your own doctor if he is not covered under the HMO plan.

  2. Find out about the limitations on pre-existing conditions, as many HMO’s will not cover them. This will only be a factor if you or a family member has a pre-existing condition that you need coverage for. Although your plan may not cover pre-existing conditions right away, they may start to cover them after you have been on the plan for a certain period of time.

  3. Make sure your specialist, if you have one, can be covered before you go see them. Under an HMO plan you MUST have a specialist referral from your chosen primary care provider, in-order to have the visit covered. You must also usually see an in-network specialist.  

  4. If you are an otherwise healthy individual, choosing an HMO plan that includes a higher deductible and higher co-pays will help you get a lower premium in return. This will keep your costs down, but will still be there if you encounter large medical bills. A $1,000 deductible will be easier to handle than $10,000 in medical bills.

  5. Learn about the appeals process that you must go through with the company in the case of a denied claim. This way you will be prepared and know how and when to appeal a non-payment. Going over this before you purchase the plan is a great idea, in order to avoid any unwanted surprises.  

  6. If your doctor isn’t part of the plan, make sure that you are comfortable changing doctors and see if your current physician knows of anyone within your plan that they can recommend. Having your current doctor recommend you to a new doctor can help ease the transition for you and make you feel more comfortable with this new person.

All in all, an HMO plan can work for you if you are comfortable with its rules and restrictions. For example, if you can find a doctor that you want to name as your primary care physician and you don ’t mind getting referrals to see anyone else, then you may forget that you’re on an HMO plan at all. If you don’t feel restricted on your HMO plan, then the lower cost is just icing on the cake.