whats an HMO? and how is it related to employer health insurance?

Question

additionally how do they fit in with other insurance policies...how about PPO...i really need some help to break all this stuff down...

Answer 1

There are different types of health insurance offered by employers. HMO and PPOs are two types of health insurance plans. In an HMO, you have to pick a doctor off an approved list and go to that doctor first if you have a problem. Let's say for instance, you think you want to see an allergist. You have to go to your selected doctor (called your PCP or primary care physician) first. That doctor may look at you and might 1) be able to take care of the problem w/o you going to an allergist 2) figure out what is wrong with you and you don't need to see an allergist or 3) decide this problem really does require you to see a specialist and he/she will refer you to one. The HMO is cheapest in terms of premiums and co-pays (your fee for a doctor visit will be like $5 or $10 if you go) but the drawback is you have to find a primary doctor (PCP) you like in your area who is taking new patients and go to him or her first before you can see a specialist. The idea behind it is good b/c a lot of people were running to expensive specialists unnecessarily and had no one coordinating their care (one dr. gives you something for sinuses that raises your blood pressure and another gives you a blood pressure medicine that messes up your sinuses) but it can be a hassle.
In the other insurace - PPO - you can go to any doctor at all whether is it a primary care doctor or a specialist, without a referral. Call up who you want and make an appt. If the doctor is on their pre-approved list, they pay more of the cost (say 80% of the visit vs. 60 - 70% of the cost of the visit if the dr is not on the approved list). This generally gives you free reign to pick who you want to see but the premiums and cost per visit are higher.
If you are young and rarely go to a dr and don't have any special problems like lung problems or immune problems, an HMO is the cheapest way to go if you don't mind the hassle. Also if you have small kids who go to the dr all the time, the low co-payments for all their millions of visits can be a big cost savings on an HMO.
If you are picky about who you see and don't want to go to a dr. with a million patients waiting in the waiting room or want a dr. who you can demand more of his/her time, you are probably better off w/ a PPO, but it will cost more.
Hope that helps and remember you can always pick a plan and most employers let you change which plan you are on at the end of each year if you want to switch.

Answer 2

If you are young and no health issues it is a whole lot cheaper than a PPO. With a PPO you pay a lot more money but you have much more freedom in who you go to and how soon you can get it. It is a problem with options when you pick an HMO. They deny stuff all the time. The bottom line is the cost. It can really be scary if you have medical issues. Some HMO's are better than others. I have an HMO now and when my employer has open enrollment where you can change insurances, I am going for a PPO. My husband was very sick and died and the HMO was so unresponsive. The medical professionals were okay, but it seemed out of their control to deal with the problems. My husband was in horrible pain, he got to a point he couldn't get around and needed a wheelchair. He was having difficulty breathing. Each required approval by the HMO which was incredibly slow. I blame them for the misery my husband was in. They didn't care at all. There was no one to really talk to in all of this. I have worked in the medical field and I have experience with this. I think about people who don't know and how alone they feel when this happens.

Answer 3

HMO = Health Maintenance Organization... This type of policy requires a Primary Care Clinic or Primary Care Practitioner ("PCC" or "PCP") Any services outside that clinic require a referral to a specialist. These policies are usually less expensive to the employer and they can pass the savings onto the members.

With a PPO (Preferred Provider Option) this does not require a primary care clinic or practitioner. These are usually higher in cost, but also offer higher level of benefit without the hassle of seeking a referral every time you need to see a specialist. With the larger carrier's like UnitedHealthcare, BlueCrossBlueShield, Medica, etc. The network is nationwide. Whereas with an HMO the provider network
is restricted to the clinic you are assigned to.

The newest trend is a high deductible plan in the form of Employer funded or Employee funded...

These can be an HRA/HSA (Health Reimbursement Account - Employer Funded... HSA - Health Savings Account - Employee Funded)

UnitedHealthcare is one of the top insurers right now. If interested, I can get you the telephone number for the local sales office in your state. (as long as you are not in Minnesota)

Hope that helps some?

Answer 4

HMOs are Health Management Organizations. PPO are preferred provider organizations. A typical HMO has a list of providers who are preferred. Go outstide the group and your claims won't be covered. Some HMOs are picky about what types of claims are covered. The HMO that my company utilizes is very lenient about what is covered, but they still require users to utilize preferred providers. Most HMOs offer low or no deductible, low copays, etc.

PPOs, on the other hand, have a list of preferred providers, but participants can elect to go to non-preferred providers, just at a lower pay schedule. The plan can be 90/10, 80/20, etc. This means that, if you see a preferred provider, your claim will be paid at 90%. You will be responsible for the 10%. Deductibles are usually higher than for an HMO.

Answer 5

HMO stands for health management organization and it is an insurance company that offers an all inclusive plan. It is less expensive than other plans that allow you to go to any doctor.

These plans are very popular since they generally cover your entire health from doctor to hospital.

Some employers will use hmo others offer just limted insurance for hospitalization.

Hmo require you to go to a medical clinic that you chose from a directory. All the doctors and most test are done there.