How to Select an HMO

To choose an HMO that meets your needs consider what's important to you in each of the following areas:

• Quality of medical care
• Quality of service
• Choice of doctors
• Medical services coverage
• Rules and restrictions
• Costs to you

Quality of Medical Care

Poor quality medical care means...

• You cannot get the treatment you need when you are ill
• HMO paperwork delays care, and a minor problem becomes a big one
• Diseases like cancer are not found early when you have a better chance of recovery
• You weren't taught how to avoid problems that make your condition worse

An HMO that provides good medical care means...

• You get the treatment that has been proven to work
• Medical problems are found early when they are best treated
• Doctors listen to your concerns and explain your treatment clearly
• You avoid complications by getting the right care at the right time

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Quality of Service

Poor quality service means...

• It's hard to find a personal doctor in the HMO who you want
• You have a large bill for medical services that you thought were covered by the HMO
• It's a hassle and takes a lot of time to see a specialist or get care

An HMO that provides good service means...

• You get care immediately when you are ill or have an urgent need
• You get answers to questions quickly and courteously
• You and each family member have a trusted, personal doctor
• HMO materials clearly explain the rules and your coverage for medical services

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Choice of Doctors

Most HMOs require members to select a personal doctor from a list of doctors who work with the plan. If you want to continue seeing your personal doctor be sure to check with the HMO to see if your doctor is part of that plan.

If you see a doctor who is a specialist—someone who treats a particular condition or health problem—find out if that doctor contracts with the HMO and if you will be able to continue to get care from that doctor.

A good HMO checks the quality of its doctors. Ask the HMO what steps it takes to make sure that its doctors have a history of good care and service.

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Medical Services Coverage

Health plans can vary a lot in how much you pay for certain medical services. Does the HMO cover most or all of the cost of services—like prescription drugs—that are important to you?

Compare how much you pay at the time you get care for medical services. Often you'll find that you pay a larger amount for certain services like a routine checkup, a weight control program or mental health care.

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Rules and Restrictions

HMOs often have rules or restrictions that affect the steps you must take to get care. For example, you may need to get an "ok" from your personal doctor and the medical group to see a specialist or to get certain tests and treatments. When traveling away from home, HMOs often limit the care you can get. Choices of prescription drugs may be restricted to those on the HMO's list. Make sure you understand the rules before you choose a plan.

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Costs to You

When comparing your cost for the HMO be sure to add up your share of the monthly insurance premium and what you pay each time you visit your doctor or get other services that are important to you. Your true costs may be very different from HMO to HMO depending upon the services you use and amount you pay each time you get care.

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