The percentage of people with employment-based health insurance dropped from 70 percent in 1987 to 61 percent in 2004. This is the lowest level of employment-based insurance coverage in more than a decade.
The
Health Maintenance Organization Plan (HMO)
Health Maintenance Organization (HMO)
plans require individuals to use a Primary Care Physician
(PCP) in the designated HMO network. Any services rendered
at a non-HMO physician will not be covered at all. These
plans are geared toward individuals who prefer referring
directly to one physician or facility that ultimately
handles all health visits and is responsible for referring
them to specialists when deemed necessary under their
care. Individuals who choose to see a specialist on
their own accord will be responsible for all costs incurred.
HMOs require no annual deductible to meet,
only a co-payment, which is an attractive advantage
for many individuals. HMO plans have become popular
because of this low-payment benefit, one of the least
expensive out of the major plans available. In addition,
individuals are never responsible for submitting any
claim forms or paperwork. The Primary Care Physicians
(PCP) are responsible for handling all claims and deal
directly with the HMO provider.
The major disadvantage of HMO plans is
that individuals cannot freely choose to see specialists
when they feel it is necessary. PCPs act as intermediaries
between patients and specialists. When a specialist
visit has been approved by the provider, the covered
individual will receive authorization and a list of
what specific services have been approved. There is
an exception when it comes to female care. Most HMO
plans do allow regular yearly visits to gynecologists
and obstetricians for prenatal care without a PCP referral.
HMOs are the oldest form of managed healthcare
plans. Individuals find them affordable and workable.
Families with children find HMOs convenient and easily
accessible when all those insured are seen under the
same PCP and all the paperwork is someone else’s
responsibility. Co-payments remain the same for all
visits and are easily paid when, for example, two or
three children are being seen by the same PCP. Ultimately,
the policyholder’s healthcare and guidance are
in the hands of one primary physician. What they decide
is best for you is what is covered under your HMO plan.
Family-Health-Insurance reviews insurance services to provide information on products and options, but is not an insurer or a licensed agency. Coverage and policies described on this site may not be available in all states.
