RELIABLE HMO INSURANCE SOLUTIONS FOR EVERYONE

1. What is HMO insurance, and how does it work?

HMO (Health Maintenance Organization) insurance is a type of health plan that provides coverage through a network of healthcare providers. Policyholders are required to select a primary care physician (PCP) who coordinates care and provides referrals to specialists within the HMO network.

2. Can I keep my current doctor with an HMO plan?

You can keep your doctor only if they are part of the HMO’s network. It’s important to check if your preferred healthcare providers are included in the network before enrolling.

3. Do I need referrals to see a specialist under an HMO plan?

Yes, most HMO plans require you to get a referral from your primary care physician (PCP) to see a specialist, ensuring care is properly coordinated.

4. What services are typically covered by HMO insurance?

HMO insurance typically covers:

• Doctor visits and specialist consultations

• Hospitalization

• Preventive care (vaccinations, screenings)

• Prescription drugs

• Emergency care
  Coverage details can vary by plan, so it’s important to review your policy.

5. Does HMO insurance cover out-of-network care?

HMO plans usually do not cover care outside the network, except in emergencies. In non-emergency situations, out-of-network treatment may not be reimbursed, or you could be responsible for the full cost.

6. What happens if I need emergency care while traveling?

HMO plans typically cover emergency care even if it’s out of the network. However, follow-up care and non-emergency services must be provided by in-network providers for coverage to apply.

7. How much does HMO insurance cost?

HMO plans generally have lower premiums compared to other types of insurance, such as PPO plans. However, costs can vary depending on your plan, location, and healthcare needs. Be sure to review the plan’s deductibles, co-pays, and out-of-pocket maximums.

8. Can I switch to a different HMO plan later?

Yes, most providers allow you to change plans during open enrollment periods. You may also switch plans if you experience a qualifying life event such as marriage, childbirth, or job loss.

9. Does HMO insurance cover mental health services?

Yes, many HMO plans cover mental health services such as therapy, counseling, and psychiatric care, often requiring a referral from your PCP. Check with your plan for specific mental health benefits and any co-pay requirements.

10. What happens if I move to another state?

If you move to another state, you will likely need to switch to a new HMO plan that offers coverage in your new area, as most HMO networks are limited to specific geographic regions.