7 Important Features of an HMO

1. Selection of providers – An HMO plan has a specific list of licensed, participating doctors and hospitals known as a “network.” This network is approved to provide covered health care services to members. It also determines how much each doctor or hospital will be paid. 2. Primary care gatekeeper – One of the main advantages of an HMO is its use of primary care gatekeepers. These are typically family doctors who are responsible for assessing patient needs and providing referrals for specialty care if needed. This is an important feature as it encourages members to get preventive care and manage chronic conditions effectively. 3. Cost efficiency – An HMO is designed to provide comprehensive coverage at a lower cost than other types of health insurance plans. This is because they are able to spread the cost of care among a large pool of members and negotiate the prices they pay to their providers. 4. Lower out-of-pocket costs – HMOs typically place more of the financial burden on the insurance company than other plans. This means that members usually have low out-of-pocket costs such as co-pays and deductibles. 5. Quality assurance – An HMO has rigorous quality assurance standards to ensure that members receive high-quality care. This makes an HMO a good choice for those who want to ensure quality care for themselves and their families. 6. Thoughtful utilization management – HMOs work to control costs by utilizing utilization