Quality health insurance is one of the numerous ways to help your senior loved one enjoy a high quality of life, whether the individual requires certain medications, surgery, physical therapy, or other treatments such as dialysis. Here, the elderly care team at Mount Washington Care Center in Cincinnati, OH, explain HMO, or Health Maintenance Organization, insurance to help you determine if it is right for the elder in your life.

HMO Insurance Explained By Your Local Elderly Care Team

How It Works

HMO insurance features a network of physicians, hospitals, and specialists providing a range of healthcare services at affordable prices. Providers accept payments at set amounts to keep health care costs reasonable for patients. Those who have HMOs must choose between physicians and other healthcare providers within the network to receive coverage. The only exceptions for out-of-network care are emergency and out-of-area urgent care, as well as out-of-area dialysis. If the patient receives any other care that is not in the plan’s network, he or she has to pay the full cost.

Prescription drugs are covered in most HMO plans. Patients also must select primary care physicians from the HMO network and obtain referrals for specialist care. Additionally, if the patient’s primary care physician stops providing services through the HMO network, the individual is notified so they can choose a new doctor.

How to Know if an HMO Plan Is Right for Your Loved One

An HMO plan may be right for your loved one because of budgetary concerns. Plans provide lower monthly premiums due to set payment levels, as well as lower copayments and minimal or no deductibles. HMOs also provide a variety of health care provider options near your older loved one, which is convenient if the person requires basic services such as annual or semi-annual checkups and immunizations. However, if specialized care is required and physicians in your loved one’s area do not provide such services, a Preferred Provider Organization plan may be best.

Mount Washington Care Center is a preferred provider for both private and HMO insurance companies and provides numerous elderly care services, including long-term care, rehabilitation, and 24-hour nursing care. The family-owned senior living facility has served the community for 34 years and provides a safe, supportive, and compassionate environment for older loved ones. Call (513) 231-4561 or visit their website today to learn more about their elderly care services.