HMO Health Plans in Georgia
Each year, more Georgians are choosing HMOs for their health insurance coverage. In 2006, over 18 percent of the population was enrolled in this type of group health insurance coverage.
In an HMO plan, patients must choose a primary care physician, who will manage their care. The primary physician will decide if a specialist is necessary, and will usually need to refer the individual to that doctor. The doctors and hospitals are usually selected from a list of providers who have agreements with that specific HMO. Patients who seek care from providers not on the list will not receive insurance coverage for those visits.
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Advantages of a Health Maintenance Organization (HMO)
- Out-of-pocket costs are usually the smallest of any type of plan
- Preventive care is emphasized, as well as patient awareness of healthy lifestyles
- Preventive care may be included with the plan at no extra charge
- There is minimal paperwork to keep track of
- A single physician takes charge of all aspects of care, eliminating conflicting treatments and simplifying patient care
- There is only a small co-pay or small deductible, depending on the individual plan
Disadvantages of a Health Maintenance Organization (HMO) Health Plan
- Any care from out-of-network providers may not be covered at all
- You must get a referral for any specialist’s care
- The emphasis on cutting costs may mean shorter doctor visits and longer waits for appointments
- Catastrophic care may not be covered in the plan
Health Maintenance Organization (HMO) Health Plan Details
The focus of an HMO is to cut costs by managing a patient’s care. A select group of providers is chosen that will give deep discounts to the insured. The insured is expected to have an exclusive relationship with one doctor, who will monitor all care. The HMO monitors the number of visits and the care received to make sure that an optimal number of visits take place. Too many visits are discouraged, as well as too few visits. The HMO also decides which treatments are permissible under the plan. The goal is to keep the insured healthy through preventive care and to catch any illnesses early in order to eliminate any extreme, expensive health care.
This type of plan may seem too restrictive if you are used to choosing your own doctor and deciding when to go to a specialist. You may also prefer that the provider makes decisions about your health care treatment instead of the HMO. However, if you have small children, an HMO will cover all well-child visits completely, making it the most affordable choice for your family.
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