Choosing An HMO

The most well known managed health care plan is the HMO, or health maintenance organization - but is it the right plan for you?

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HMO: the basics

Under an HMO, you pay a fixed monthly fee called a premium. Your coverage includes certain medical services from a specific network of physicians.

You choose a primary care physician, who is responsible for your health care, making referrals to specialists and approving further medical treatment.

HMOs require you to make a co-payment for medical services you receive.

Care received from a physician outside the network in not covered.

HMO: the pros and cons

HMOs do not require extensive paperwork, are cheap and focus on preventative medical care.

However, HMOs limit your choice of physicians and specialized care can often be difficult to obtain. Medical services from a health care provider outside the network are never covered.

HMO: the price

The cost of an HMO is typically low. You pay a monthly premium and co-payments for services rendered.

HMO: questions

To guide your search for a quality HMO, we've listed questions you should always ask about this typed of managed care plan.


  • How many doctors can I select from?
  • Does the network include private or group practice physicians?
  • Which doctors have openings for new patients?
  • How easily can I change my primary care physician?
  • What is the process for specialist referrals?
  • How quickly can I get an appointment?
  • How long will I wait for routine visits?
  • How is emergency care handled?
  • What medical services are covered?
  • Are there limits to medical services?
  • What happens if a special service is needed but not covered?
  • Where are the network hospitals located?
  • How can I get medical attention if I am out of town?
  • What is the yearly total for my health insurance policy?
  • Are there any copayments? For which services and how much?

Here is a printer-friendly version of the questionnaire. Make note of the answers to each question for policy comparison.

Choosing an HMO

HMO premiums vary. To save money, compare as many plans and companies as possible.

Get instant health insurance quote from eHealthInsurance, or you can get information directly from local agents who will provide you with tailored premium quotes.


Next: PPOs

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