HMO Health Insurance: Everything You Need To Know

The Essential Guide On How HMO Health Insurance Works

Are you confused about health insurance? Have you heard about HMO Health Insurance but don’t know what it is? In this article, we will break down everything you need to know about it. This way, you can decide if it is your best option. 

A Health Maintenance Organization (HMO) is a member-centered form of insurance. Unlike Preferred Provider Organizations (PPO), which provide a network of providers, the HMO provides a smaller pool of physicians and hospitals for its members. 

HMO plans are affordable, but only if you stay in-network. If you go outside the network, you must cover your medical expenses. HMO health insurance has other details to keep in mind, so read below to learn more before consulting with South Dakota health insurance agents

HMO Health Insurance: Everything You Need To Know

How Does An HMO Health Insurance Plan Work?

With a HMO plan, you must select a primary care provider from the network in your health plan. This plan usually covers many services, including flu shots, blood pressure screenings, etc. HMO plans also cover primary care services. To visit a specialist, such as a cardiologist or a dermatologist, you must get primary care services first. The primary doctor must refer you to in-network specialists after that. 

If you go outside the HMO network for health services, you will probably have to file a claim to be reimbursed for medical expenses. You may have to do the same in an emergency. However, you are more likely to pay out-of-pocket. 

How Much Is The HMO Health Insurance?

The prices vary depending on the plan and the healthcare provided, but HMO health insurance plans tend to be the most affordable. They come with lower deductibles than other health insurance plans. The only issue is that you will pay higher prices if you visit a specialist outside the HMO’s approved network. 

What Services Does A HMO Health Insurance Plan Include?

You can learn more about the HMO details by asking your trusted South Dakota health insurance agents. We can give you some general information about the services HMO plans cover.

HMO health insurance typically covers numerous preventive services, including vaccines, routine screenings, and more. They cover primary health services too. 

Some HMO plans restrict how many times you can visit the doctor in a year before checking other healthcare costs. 

Can I Use Primary Care Services With HMO?

As previously mentioned, an HMO plan covers primary care services, so you must visit a primary care physician before a specialist. Your primary care physician will refer you to specialists if needed. 

The primary care physician must check all health services to avoid extra healthcare costs. This requirement helps you keep better budget control while paying the plan.

Read the provider’s list to choose your primary care physician or doctor. You can find this list on your health insurance company’s website. 

How Can I See A Specialist With A HMO Health Insurance Plan?

You can see a specialist only if your primary care physician refers you to it. The primary care doctor will refer you to in-network specialists if necessary. Keep in mind that you receive a penalty if you visit a specialist outside your HMO’s plan. Talk to your South Dakota health insurance brokers for more details about penalties. 

The penalty could include paying for the cost of the appointment out-of-pocket. 

How To Fill Prescriptions With A HMO Health Insurance Plan

Prescriptions are covered by the plan if the primary care doctor gives you one. But, you can always see the price outlined in the HMO’s drug formulary. 

The place to fill the prescription may change depending on the health insurance plan. For example, some HMO plans may partner with retail pharmacies like CVS or Walmart, while others have their pharmacies. 

You may have to pay additional healthcare costs if you request prescriptions outside the HMO’s network.

When Can I File A Claim With A HMO Plan?

You may need to file claims for certain services. In some cases, your primary care physician may require claims too. If you visit a specialist outside the network to receive a medical service that the primary doctor didn’t request, you will also have to file a claim. This claim is mandatory if you wish a reimbursement.

Where Can I Find South Dakota Health Insurance Agents?

You can learn more about HMO Health Insurance plans by contacting health insurance agents. If you are looking for a top-rated health and life insurance agency, call South Dakota Health Insurance now for a reliable and trusted service. We help you choose the best health insurance plan in South Dakota according to your needs. Contact us now to get started and learn more! 

South Dakota Health Insurance
5040 Saturn Dr,
Rapid City, SD 57703

Tel: 605-653-3824