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What are the Advantages and Disadvantages of HMO Care?

Malcolm Tatum
Updated Mar 03, 2024
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The health management organization, or HMO, is a viable medical plan that serves as the healthcare coverage for many people. Over the years, this form of medical insurance has been alternatively praised and condemned among patients and health care professionals alike. If you are considering the possibility of using HMO care as your health plan of choice, here are some of the benefits and drawbacks commonly observed by supporters and detractors.

There are a number of advantages associated with HMO care. One has to do with cost. In terms of the monthly premium, health insurance through an HMO simply costs less. This is true whether the individual pays the entire premium or an employer picks up all or part of the monthly charge. In addition, many plans do not have any type of deductible or require a co-payment from the member. From this perspective, this type of care is immediately attractive to any individual or business where there is only a limited budget for medical coverage.

HMO care also carries the advantage of establishing a network of health care providers that are readily available to each member of the organization. Most health maintenance organizations require that a new member choose or be assigned a primary care physician from their roster of local medical doctors. For people who have never had one general practitioner that they see at least annually, this requirement is often viewed as a positive situation.

With this type of care, the primary physician functions as the gatekeeper for each member in his or her client group. When there is a need to refer a patient to a specialist, the primary doctor makes all the arrangements, scheduling the appointments with a specialist who is also associated with the HMO. Not only is this convenient for the patient, but it also helps to ensure the services of the specialist are covered under the plan, minimizing the potential for out of pocket expenses for the HMO member.

While there are many good points to HMO care, there are also a few concerns that have emerged over the years. One common complaint is that new members often must abandon their current primary care physician in favor of a doctor associated with the HMO. This can be troubling for anyone who has a great deal of confidence and trust in his or her current physician.

A similar concern has to do with the selection of a primary care physician. Some HMO care plans allow the member to choose a physician from a list. Others simply assign the member to an in network doctor. Switching from one HMO physician to another on the same network is not always an easy task. The result is that some HMO members feel stuck with a doctor they don’t particularly like or trust.

Seeing a specialist is out of the question without a referral in most HMO programs. Even if the specialist is in the local HMO network, most plans require that the primary care physician provide a referral before the appointment can be scheduled. This can be an issue, since the very nature of an HMO often creates a situation where the primary doctors are expected to keep medical costs low. If the doctor is more interested in the bottom line and less in the welfare of the patient, obtaining a referral can be a hard and sometimes impossible task.

Should your assigned primary care physician decide to leave the network, the HMO program will reassign you to another physician, often before you know that your doctor is no longer available. This makes it necessary to essentially start over with another doctor and attempt to build a working physician/patient relationship all over again. If there is a frequent turnover in a given HMO, members may find themselves going through this process two or more times each calendar year.

Former members of HMO care programs have also noted that many primary care physicians are inundated with huge numbers of assigned patients. This creates a situation where the doctor is bound by a contract to treat the patients as quickly as possible. As a result, patients are often hurried through the process, making it much easier to overlook important signs or symptoms. This opens the door for a serious ailment that is just forming to go unnoticed until it is apparent enough to require extensive treatment.

While there are some very good points to HMO care plans, the quality of plans vary from one provider to the next. Before committing to any HMO, make sure you get information on the size of the local network, what options the members will have in choosing a primary care physician, and the rate of turnaround within the local network. This will help you to have a better idea of whether you are likely to encounter more benefits and less disadvantages if you choose to obtain this type of medical care coverage.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Malcolm Tatum
By Malcolm Tatum
Malcolm Tatum, a former teleconferencing industry professional, followed his passion for trivia, research, and writing to become a full-time freelance writer. He has contributed articles to a variety of print and online publications, including The Health Board, and his work has also been featured in poetry collections, devotional anthologies, and newspapers. When not writing, Malcolm enjoys collecting vinyl records, following minor league baseball, and cycling.
Discussion Comments
By Moldova — On Jan 25, 2011

GreenWeaver- This is a frightening bill because any place that has instituted socialized medicine like this has always had a higher death rate among its people.

The reason for this is the rationing of healthcare. Some life saving drugs might be out of reach due to the cost.

For example, in France they recently developed a vaccine to treat breast cancer that can actually be used to treat other forms of cancer. It has been known to shrink cancer cells but this medication is not offered in the UK because of its cost.

That is what will happen in the United States if this bill stays in effect. Not only would we destroy the best healthcare system in the world, but there would be an increase in mortality rates because treatments and drugs would be deemed too expensive.

Just look at the UK whose prostate cancer survival rates are 60% while the US boosts survival rates of 95%. This is one disease if you multiply it by all of the possible conditions and ailments you will see why the mortality rate in the United States would skyrocket under this Obamacare bill.

By GreenWeaver — On Jan 22, 2011

Sneakers41-I had an HSA account but Obama did away with it with that health care bill that nobody wants.

With this bill we went from having our own choice of doctors to choosing state mandated doctors.

The inclusion of all preexisting conditions really makes private insurance obsolete because the purpose of insurance is to cover your expenses should a disaster strike.

This would be the equivalent to having a car accident and signing up with an insurance company expecting them to pay for the damages. The insurance is to cover you in case of a problem not after it developed.

By sneakers41 — On Jan 19, 2011

Comfyshoes-I agree which is why I have a PPO instead of HMO coverage.

With a PPO you have the flexibility of choosing the doctor that you want for preventative and wellness visits.

For elective surgeries or medically necessary surgeries if you select a doctor outside of the plan it still would be covered but it would be covered for a percentage like 60% of the medical bill.

An in network doctor would be covered at 100%. You do pay higher premiums and your copayment might be slightly higher as well but to get coverage to see your preferred doctor for general checkups which is really worth it.

I actually prefer the HAS or the Health Savings Account. It works by allowing you to place pretax earnings into a fund to use for healthcare expenses.

The drawback is that the deductibles are high. Generally a deductible for a family of four might be $1,500 which means that you have to exhaust the $1,500 in healthcare expenses in order to receive coverage.

The plan actually is a good one and eases the healthcare system because you pay out of pocket for preventive healthcare measures and anything else if covered by insurance.

Too many people would use their insurance for everyday things. They would go to the doctor for a simple cold, but with an HSA account you would have to pay until you reached your deductible so less people would use their insurance for frivolous reasons like this.

By comfyshoes — On Jan 19, 2011

The main advantage for people that have HMO health care coverage remains the low copayments and overall health insurance premiums.

People usually seek this option for its reduced cost but it does have its disadvantages. The main disadvantage is that you are restricted to see only the doctors that participate in the network.

So with HMO coverage if your doctor falls outside of network, you will have to pay out of pocket for all medical services because your doctor is not classified as one of the HMO providers.

All of the HMO healthcare provides runs the same way. It does not matter if you have PacifiCare HMO, Unicare HMO, HMO Aetna, or even HMO Medicare. If you consider a HMO medical physician within the network than you would only pay a small copayment.

This is the main drawback with HMO plans because it limits your provider options significantly.

Malcolm Tatum
Malcolm Tatum
Malcolm Tatum, a former teleconferencing industry professional, followed his passion for trivia, research, and writing...
Learn more
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