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What Does HMO Mean?

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Networked Providers Can Mean Lower Costs

As a working mom, you're probably concerned about the cost of health care. An HMO might be an effective way to manage costs if you and your family are generally in good health.

Why Choose an HMO?

A Health Maintenance Organization, or HMO, is a network of doctors, hospitals and other health care providers who have agreed to accept payment at certain levels for the services they provide. By doing so, the HMO can keep costs in check for its members.

HMOs can usually offer lower premiums than other types of insurance plans. In general, they have lower co-pays and co-insurance, helping to make them more affordable.

Selecting Your Provider

With an HMO, you choose a primary care physician (PCP) from a network of local providers. If specialty care is necessary, your PCP will make a referral to an in-network specialist. For example, if you are having back pain, you would be examined first by your PCP. She would then refer you to a neurologist, orthopedic surgeon or other medical professional. As long as the specialist is in your network, services are covered by your HMO insurance after you meet the deductible and co-pays.

Can I Keep My Current Primary Care Physician?

That's no problem if he or she is part of the HMO's network. If not, you may want to consider a Preferred Provider Organization (PPO) instead. In some states or on some plans, PPOs do not require that you choose a primary care physician. Typically, you can see any doctor and use any hospital. If you want to see a specialist, you do not need a referral first. PPOs offer more flexibility, but the insurance plans usually have higher premiums.

Dental HMO Plans

A dental HMO works in the same way as a medical HMO: You choose a general dentist within a network for routine, preventive and diagnostic care. As your primary provider, the general dentist will make specialty referrals as necessary.

Is an HMO Right for My Family?

HMOs don't cover out-of-network costs, except in the case of a true emergency. If you or any members of your family travel frequently, it may be difficult to find a health care provider when you're out of town and get the necessary authorization from your network. If the services of specialists are required, you do not have the freedom to choose your doctor or hospitals; you must stay in-network. HMOs are best for individuals who are in good health and generally need only routine care, such as an annual physical exam or immunizations.