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HMO-The Full Story

When you are searching for low cost health insurance an HMO plan is likely to come across your radar. HMOs, or health maintenance organization plans, offer some of the lowest cost full coverage insurance benefits but they have certain drawbacks.

With an HMO, you will be treated exclusively by doctors and medical treatment centers that are in the HMO network. If you receive treatment from someone outside of this network, unless it is an unpreventable emergency, your claim is likely to be denied. Unlike a PPO, HMOs do not offer any coverage for treatment received outside the network unless it is emergency treatment in an area with no network treatment centers or physicians. So if you have a favorite doctor that you or your children visit, make sure he or she is on the network list before you take out the HMO’s low cost health insurance coverage. If you don’t, then you will be forced to pay out-of-pocket for the full cost of all your visits to this physician.

With an HMO you are likely to have a copayment amount each time you visit a doctor or treatment facility. The copayments are fixed dollar amounts that will be listed out on your policy and possibly on your insurance card. They do not vary although they may be increased when your policy is renewed.

Some HMO plans have deductibles which is an amount of money that you must pay out-of-pocket before the policy kicks in and pays a benefit. These deductibles are variable and you can choose yours when you take out your policy. The larger your deductible the less expensive your insurance premium will be.

Your policy will also have a limit, or cap, in the amount of benefit you can receive over your lifetime. This protects the insurance company from having to commit to pay too much in benefits. Since the limits are usually set above one million dollars, it’s doubtful that most consumers will need to worry about exceeding them.

Remember, check your rates, choose an affordable deductible and a reasonable limit, and check that your favorite physicians are on the network list before you take out an HMO plan. Then your family will be happy, safe, well cared for and not at financial risk.

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