{"id":752,"date":"2017-11-08T05:22:49","date_gmt":"2017-11-08T10:22:49","guid":{"rendered":"https:\/\/multi.nycnewsnetwork.com\/healthynyc\/nyc-health-insurance-what-is-an-hmo-plan-health-maintenance-organization\/"},"modified":"2017-11-08T05:22:49","modified_gmt":"2017-11-08T10:22:49","slug":"nyc-health-insurance-what-is-an-hmo-plan-health-maintenance-organization","status":"publish","type":"post","link":"https:\/\/nycnewsnetwork.com\/healthynyc\/nyc-health-insurance-what-is-an-hmo-plan-health-maintenance-organization\/","title":{"rendered":"NYC Health Insurance: What is an HMO Plan? (Health Maintenance Organization)"},"content":{"rendered":"<p>Health Care is extremely important for New Yorkers right now, making it even more important to understand the terminology, in order to be as informed as possible about what the doctor or insurance plan is trying to sell you. This week let&#8217;s take a look at understanding the &#8220;HMO&#8221;.<\/p>\n<p>You might hear people refer to some health plans as HMO, which stands for Health Maintenance Organization.\u00a0HMOs have their own network of doctors, hospitals and healthcare providers.\u00a0 \u00a0These provides have agreed to accept payment at a certain level for any services they provide. This allows the HMO to keep costs in check for its members.<\/p>\n<p>In most HMO Plans, you\u00a0generally must get your care and services from\u00a0doctors, other health care providers, or hospitals\u00a0in the plan&#8217;s\u00a0network. You may also need to get a referral from your primary care doctor.<\/p>\n<h2>Can I get my health care from any doctor, other health care provider, or hospital?<\/h2>\n<div>\n<p>In HMO Plans, you generally must get your care and services from doctors, other health care providers, or hospitals in the plan&#8217;s network, except:<\/p>\n<ul>\n<li>Emergency care<\/li>\n<li>Out-of-area urgent care<\/li>\n<li>Out-of-area dialysis<\/li>\n<\/ul>\n<p>In some plans, you may be able to go out-of-network for certain services, but it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option.<\/p>\n<\/div>\n<h2>Are prescription drugs covered?<\/h2>\n<div>\n<p>In most cases, prescription drugs are covered in HMO Plans. Ask the plan. If you want\u00a0<a class=\"glossary\" style=\"margin: 0px; padding: 0px; border-width: 0px 0px 1px; border-color: initial; border-image: initial; outline: 0px; font-weight: normal; font-style: inherit; font-size: 13.8px; font-family: Arial; vertical-align: baseline; color: #4c4c4c; text-decoration: none; cursor: pointer !important; border-style: initial initial dotted initial;\" title=\"&lt;p&gt;Optional benefits for prescription drugs available to all people with Medicare for an additional charge. This coverage is offered by insurance companies and other private companies approved by Medicare.&lt;\/p&gt;\" href=\"https:\/\/www.medicare.gov\/sign-up-change-plans\/medicare-health-plans\/medicare-advantage-plans\/hmo-plans.html#1371\" name=\"1371\">Medicare prescription drug coverage (Part D)<\/a>, you must join an HMO Plan that offers prescription drug coverage.<\/p>\n<\/div>\n<h2>Do I need to choose a primary care doctor?<\/h2>\n<div>\n<p>In most cases, yes, you need to choose a primary care doctor in HMO Plans.<\/p>\n<\/div>\n<h2>Do I have to get a referral to see a specialist?<\/h2>\n<div>\n<p>In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don&#8217;t require a referral.<\/p>\n<\/div>\n<h2>What else do I need to know about this type of plan?<\/h2>\n<ul>\n<li>If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another doctor in the plan.<\/li>\n<li>If you get health care outside the plan&#8217;s\u00a0<a class=\"glossary\" style=\"margin: 0px; padding: 0px; border-width: 0px 0px 1px; border-color: initial; border-image: initial; outline: 0px; font-weight: normal; font-style: inherit; font-size: 13.8px; font-family: Arial; vertical-align: baseline; color: #4c4c4c; text-decoration: none; cursor: pointer !important; border-style: initial initial dotted initial;\" title=\"&lt;p&gt;The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.&lt;\/p&gt;\" href=\"https:\/\/www.medicare.gov\/sign-up-change-plans\/medicare-health-plans\/medicare-advantage-plans\/hmo-plans.html#4842\" name=\"4842\">network<\/a>, you may have to pay the full cost.<\/li>\n<li>It&#8217;s important that you follow the plan&#8217;s rules, like getting prior approval for a certain service when needed.<\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.medicare.gov\/find-a-plan\/questions\/home.aspx\">Find and compare HMO Plans in your area<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Health Care is extremely important for New Yorkers right now, making it even more important to understand the terminology, in order to be as informed as possible about what the doctor or insurance plan is trying to sell you. This week let&#8217;s take a look at understanding the &#8220;HMO&#8221;. You might hear people refer to [&hellip;]<\/p>\n","protected":false},"author":5780,"featured_media":753,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4,7,5],"tags":[],"class_list":["post-752","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","category-health-plans","category-retirement-plan-nyc"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v23.4 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NYC Health Insurance: What is an HMO Plan? 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You might hear people refer to [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/nycnewsnetwork.com\/healthynyc\/nyc-health-insurance-what-is-an-hmo-plan-health-maintenance-organization\/\" \/>\n<meta property=\"og:site_name\" content=\"Healthy NYC\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/HealthyNYC.official\/\" \/>\n<meta property=\"article:published_time\" content=\"2017-11-08T10:22:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/nycnewsnetwork.com\/healthynyc\/wp-content\/uploads\/sites\/8\/2017\/11\/What-is-an-HMO-2017.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"900\" \/>\n\t<meta property=\"og:image:height\" content=\"600\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Sarah Morales\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@healthynyc_\" \/>\n<meta name=\"twitter:site\" content=\"@healthynyc_\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Sarah Morales\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"NewsArticle\",\"@id\":\"https:\/\/nycnewsnetwork.com\/healthynyc\/nyc-health-insurance-what-is-an-hmo-plan-health-maintenance-organization\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/nycnewsnetwork.com\/healthynyc\/nyc-health-insurance-what-is-an-hmo-plan-health-maintenance-organization\/\"},\"author\":{\"name\":\"Sarah Morales\",\"@id\":\"https:\/\/nycnewsnetwork.com\/healthynyc\/#\/schema\/person\/fe882d65bd0628d2053dcad8a7a04c90\"},\"headline\":\"NYC Health Insurance: What is an HMO Plan? 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