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HMO Plans in Michigan

Each year, more Michiganians are choosing HMOs for their health insurance coverage. In 2006, more than one-third of the state population was enrolled in this type of group health insurance. In an HMO plan, patients choose a primary-care physician, who manages their care. The primary physician decides if a specialist is necessary, and refers the patient to that doctor. The doctors and hospitals are chosen from a list of providers who have agreements with that HMO. Patients who seek care from providers not on the list will not receive insurance coverage for those visits.

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Advantages of a Health Maintenance Organization:

  • Out-of-pocket costs are the lowest of any type of plan
  • Preventive care is emphasized, as well as patient education about healthy lifestyles
  • Preventive care may be included with the plan at no extra charge.
  • Minimal paperwork
  • A single physician takes charge of all aspects of care, eliminating conflicting treatments and simplifying patient care.
  • There is only a small co-pay or small deductible, depending on the plan

Disadvantages of a Health Maintenance Organization:

  • Care from out-of-network providers may not be covered.
  • Referrals are required for any specialist's care.
  • The emphasis on cutting costs may mean shorter doctor visits and longer waits for an appointment.
  • Catastrophic care may not be covered in the plan


Health Maintenance Organization (HMO) Plan Details

The focus of this type of health care is to cut costs by managing a patient's care. A select group of providers is chosen that provide deep discounts to the insured. The insured is expected to have an exclusive relationship with one doctor, who will monitor all care. The HMO monitors the number of visits and the care received to make sure that an optimal number of visits take place. Both too many visits and not enough visits are discouraged. The HMO governing board also decides which treatments are permissible under the plan. The goal is to keep the insured healthy through preventive care and to catch any illnesses early in order to eliminate any extreme, expensive health care.

This type of plan may seem too restrictive if you are used to choosing your own doctor and deciding when to go to a specialist. You may also prefer that the provider makes decisions about your health care treatment instead of the HMO. However, if you have small children, an HMO will cover all well-child visits completely, making it the most affordable choice for your family.

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