Also, HMOs operate on the concept of capitation - they receive a flat fee each month for each person they cover. What most people dislike is the requirement that you use only doctors and hospitals that are part of the HMO plan. This is far less expensive than the usual 80 percent reimbursement of traditional health care insurance.īut there are disadvantages as well. Lastly, many HMOs require only a small co-payment for a visit to the doctor, a hospital stay, or a prescription. Secondly, HMOs and most other types of managed care do not require that you pay for your medical care up front, so there are no claim forms to fill out or waiting periods for repayment. First, the premiums of managed care are usually lower than traditional health insurance, which can end up saving you money if you are now paying any of your own insurance costs. The most obvious advantage to belonging to an HMO is cost. If you need other types of care, such as seeing a specialist or going to the hospital, you are first required to get approval from your primary care provider. Also, HMOs usually require you to choose a primary care physician who will be in charge of your health care. Your HMO will provide you with a list of in-network doctors. They all require you to use doctors and hospitals that are "in-network" or part of their HMO plan. While all HMOs will provide you with written material about how their program works, they all have a few things in common.
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