Learn the Advantages and Disadvantages of Joining an HMO
6. You will need a separate dental plan (and sometimes eyesight as well).
When you enroll in a medical HMO plan, your coverage extends to your primary care physician and other in-network providers who can give interventions anytime you have a health problem that needs to be addressed. If you need to see your dentist for a root canal, you must have a different dental plan to receive that coverage. You may require a third plan to address your eyesight demands.
Although some HMOs combine all of these services into one plan, there’s a good possibility you’ll be paying multiple premiums with this healthcare choice.
7. An HMO increases the likelihood of acquiring unnecessary services.
Although some HMOs are evolving toward a value-based patient experience, the fee-for-service model remains prevalent in many of these plans. That means your PCP can bill you for any extra services you receive during an appointment, such as an extra office visit, if your time runs out. If your doctor is trying to pad their bottom line, you may encounter unnecessary service demands throughout your visit. To prevent spending more out-of-pocket charges than necessary, always inquire about what you are receiving and why it is required.
8. If you don’t like your PCP, you can be stuck with it.
HMOs are the least expensive way to obtain healthcare in the United States, but they are also the most restrictive. If you have an issue with your primary care physician, you are stuck with him or her unless your coverage changes. You may be unable to continue seeing that doctor if the managed care programs change. When the contract expires, the medical clinic that supports the physician may also drop out of the HMO, leaving you scurrying to find someone else. Because the premiums are only enough to cover costs, it is fairly uncommon for many institutions to come and go with this plan.
9. Supplemental insurance coverage is not available in all HMOs.
In the United States, if you have a Medicare HMO, you are not permitted to use supplemental insurance with that coverage. Even if you have extra insurance from a prior employer or a private organization, you cannot use it with the government’s Health Maintenance Organization plan. When you have a serious medical illness, the coverage provided by supplemental insurance can truly help with your finances because it can contain extras such as travel insurance that will cover all of your care expenditures. It may also provide hospitalization coverage that you do not already have if you are a member of an HMO.
10. In smaller networks, there may be a long wait to join a PCP.
In some HMOs, doctors have the authority to limit the number of patients they visit. If you reside in a small town where access to medical care is already challenging, finding a doctor to act as a primary care physician (PCP) may be difficult. Even if your initiative is successful (due to requirements or availability), the waiting period for your initial meeting could be up to three months. That is why it is critical to investigate all of your alternatives to ensure that your doctor can assist you straight immediately.
11. Your PCP may be a significant distance away from your home.
Because you must use a certain PCP as your first point of contact with a Health Maintenance Organization, you may discover that getting to your care provider’s office is a difficult experience. If you live in a small town, you may be required to travel several miles to visit the network’s nearest doctor. If they are unwilling to accept new patients, you will choose the doctor nearest to you. The present travel time and distance to the doctor are approximately 20 minutes and 9 miles in the city, while it is closer to 30 minutes and 22 miles in rural areas – and this is only for routine care. If you want to see a specialist, you’ll have to travel much further.
The Bottomline
If you are seeking affordable healthcare options through your work benefits, an HMO is a viable option to examine if you can live with the plan’s limitations. You will have restricted options for PCPs, will need referrals for any special treatment, and will have to jump through some administrative hoops for specific tests or services if you don’t want to be hit with a huge cost afterward.
Because of the necessity for referrals, an HMO is not the best option if you or someone in your family requires ongoing care from a specialist. If you only go to the doctor once a year, this is a great way to save money.
Because the cost savings must come from somewhere, the pros and drawbacks of an HMO reveal that this healthcare plan is not the ideal option for everyone. If you can regularly manage the drawbacks well, you might want to consider this alternative.
