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Family HMO Insurance Plans
By: Mike Singh

Are you looking for convenient access to health care? If so, consider the many choices offered through family Health Maintenance Organization (HMO) plans. With HMO's you normally do not have to pay a deductible if you visit a health care provider that participates within the HMO network. The co-pays are relatively small and the service varied.

How does an HMO plan work?

One of the many benefits of an HMO plan is that the out-of-pocket expenses that you incur are limited to a fixed dollar amount as long as the medical care you receive is within the HMO network. With an HMO, you are required to select a Primary Care Provider (PCP) from within the HMO network. This medical professional will be the first contact for all your medical needs. If you were to require further medical treatment, your PCP will complete a referral so that you can see a specialist to further aide in your health care. The type of care covered with family HMO plans include:

  • Physician and outpatient care
  • Hospital care
  • Behavioral health services
  • Emergency services
  • Other services such as medical equipment, home health visits, etc.

You will find the detail of coverage provided in the packet of information you receive from your provider of health insurance.

What type of premium and co-payments can you expect with an HMO plan?

Often times, you will pay a higher premium with family HMO plans. The reason for this is that the amount you pay is normally lower than with other insurance programs. Based upon the type of services you select and the plan you choose determine the amount of your copayment. You may pay up to $25 for your PCP (or lower) and up to $300 for hospitalization. Therefore, look carefully at the plans and choose one that fits within the needs of your family.

There are some HMO plans that have a deductible and this usually pertains to prescription drug care. Other plans do not due to the agreed upon contract for your out-of-pocket expenses regarding health care services.

What are the benefits and drawbacks of family HMO plans?

With an HMO plan, you can choose to open a Flexible Spending Account (FSA). This type of account allows you to set aside money for copayments, prescription drug therapy, along with other items that are part of an approved list - tax free. When choosing an HMO plan it is important to find a medical professional that is on the approved list that also meets the needs you have for your family. HMO plans normally only cover those doctors and or services that are within their network, unless of course you encounter an emergency. Your PCP is the hub around all other necessary medical services.