Health Maintenance Organization - HMO in Georgia (GA)
An HMO is a prepaid health plan. As an HMO member, you pay a monthly premium. In exchange, the HMO provides maintenance care for you and your family, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy. HMOs arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract.
Usually, your choices of therapy, diagnosis, doctors and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies or when obviously medically necessary.
Because HMOs receive a fixed fee for your covered medical care, it is theoretically in their interest to make sure you get basic health care for simple problems before they become serious. Often, the HMO shifts the financial risk for your care to the doctors they contract with by paying a fixed monthly payment for each patient under the doctors care. This is called "capitation". Any treatment a patient receives under this system decreases the HMO's or the doctor's income. This replaces a possible incentive under a fee-for-service system to provide unnecessary care, with an incentive to do too little. HMO coverage typically includes preventive and early detection care, such as office visits, immunizations.
- High Deductible Health Plan (HDHP) - Combined with HSA or HRA gives greater flexibility and tax advantages to save on medical expenses.
- Health Savings Accounts (HSA) - Pay for current health expenses and save for qualified medical and retiree health expenses, tax-free.
- Health Reimbursement Arrangement (HRA) - Employer-funded account to reimburse allowable medical expenses.
- Health Maintenance Organization (HMO) - A prepaid health plan where HMO provides maintenance care for you and your family.
- Preferred Provider Organization (PPO) - Providers would provide a substansial discount below their regularly-charged rates.
- Point of Service (POS) - Direct your own health care as you would under an indemnity plan but there is a provision to opt out of the plan.
- COBRA (Consolidated Omnibus Budget Reconciliation Act) - health plan for a limited time when there is job loss, transition, death, divorce.
