As of the 2000 U.S. Census, over 25 percent of the Ohio residents were enrolled in HMOs for their health insurance coverage. In an Ohio HMO plan (which stands for health maintenance organization), patients choose a primary-care physician from the doctors who work for the plan. That doctor manages the medical care for those patients.
The primary physician determines if a specialist is necessary, and refers the patient to that doctor. The doctors and hospitals are members of a list of providers who have agreements with that HMO. Patients who choose treatment from providers not on the list will not be paid insurance reimbursements for those visits.
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Advantages of a Health Maintenance Organization:
- Out-of-pocket fees are the lowest of all the health insurance plans.
- Preventive care is stressed, as is education about healthy lifestyles.
- Preventive care may be part of the plan, but at no extra charge.
- There is minimal paperwork.
- A chosen physician determines all aspects of care, eliminating conflicting treatments and streamlining patient care.
- A small co-pay or small deductible may be required.
Disadvantages of a Health Maintenance Organization:
- Visits to out-of-network providers are not covered.
- Referrals are required for any specialist treatment.
- The stress on lower fees may cause shorter doctor visits and longer waits for an appointment.
- Catastrophic medical care may not be included.
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Health Maintenance Organization (HMO) Plan Details
The emphasis of this sort of health care is to cut fees by managing a patient’s care. A designated group of providers is gathered that provides deep discounts to the insured. The insured is required to have an exclusive relationship with one doctor, who will keep track of all care. The HMO controls the number of visits and the care received to ensure that an ideal number of visits takes place.
An HMO generally discourages both too many visits and not enough visits. The HMO governing board also determines which treatments are allowed. The goal is to keep the patient healthy through preventive care and to treat any illnesses early in order to eliminate any extreme, expensive health care.
This type of plan may seem too limiting for those who are used to choosing their own doctor and deciding when to go to a specialist. You may also want the provider to make decisions about your health care treatment instead of the HMO. However, for those with small children, an HMO will cover all well-child visits totally, making it the most affordable choice for a family.
