Updated May 29, 2015.

You pay a lot for your HMO, so learn to get the most from it. If you don’t take advantage of your HMOs best benefits, or don’t use your HMO wisely, you won’t get the most bang for the bucks you’re paying in monthly premiums.

 

To Get the Most From Your HMO, Start by Choosing a Good One

• Check quality rating and customer satisfaction scores when choosing your HMO. Getting the most bang for your buck with an HMO starts with making sure you’re getting good quality care. Even if you do all of the other things on this list, if you’ve chosen a lousy HMO to start out with, you’re not likely to get the most for the money you’re paying in monthly health insurance premiums.
  
  You can get health insurance quality and customer satisfaction data from the National Committee for Quality Assurance. If you already have an HMO in mind, use the NCQA’s report card feature to get a report card on that plan. If you don’t have a specific plan in mind, use NCQA’s plan rankings to find highly ranked plans. Learn more about what those NCQA rankings mean in this Consumer Reports article.

• Choose an HMO with a network that will meet your needs. Look for lots of in-network providers located near your home and work. The HMO’s network will play a big role in how you use your health insurance. To get the most from your HMO, you need to be able to access its provider network easily.
  
  For example, if your HMO doesn’t have a nearby in-network urgent care center or minor injury clinic open after-hours, it’ll be harder to get a minor but annoying thing taken care of if it pops up after office hours. Likewise, if the HMO’s nearest emergency room is a 45 minute drive from your home, you’re not likely to go there during a true emergency. You’ll pick a closer out-of-network emergency room.
  
  For another example, let’s say you need a cardiologist. You discover too late that the only in-network cardiologist within 100 miles of your home is a jerk. You don’t respect him or her, and you dread your cardiology appointments.
  
  Since you probably won’t follow-up with the cardiologist like you’re supposed to, you won’t be getting the most from your HMO, and you won’t be doing your health any big favors, either. However, if there are 10 in-network cardiologists within 20 miles of your house, if the first one you’re referred to is a jerk, you can switch to another.

 

How Do I Get the Most From My HMO When I Use It?

• Take advantage of the preventive care and wellness programs your HMO provides. These preventive care services can save your life or prevent a disability down the line, so take them seriously. You’re paying for the cost of preventive services in your monthly premiums, so get your money’s worth from your HMO and get the preventive care you’re already paying for.
   
• Choose your primary care physician wisely, and cultivate that relationship. Your relationship with your primary care physician is especially important in an HMO because he or she acts as a gatekeeper to all of the rest of the HMOs services.
  
  If you dislike your primary care physician, change to another one. If you were to get bad news, would your primary care physician give you that news in a sensitive, caring manner? He or she will be your wing-man when you’re fighting a serious disease. Do you trust them in that position? If your answer is no, find an in-network primary care physician that you’re willing to trust with your life. It’s really that important.
• Follow through on multi-step treatment plans. In order to keep costs in check, HMOs frequently require members to try the least expensive treatment option first and only progress to more expensive options if the cheap treatment fails. This can involve multiple doctor visits, lots of switching prescriptions, and jumping through some hoops before you get to the treatment option you wanted in the first place.
  
  Keep with it. Your persistence will be rewarded with a treatment that works for you and suits your lifestyle, but only after you’ve tried and failed all the cheaper options that didn’t work for you. You won’t get the most from your HMO if you give up half way through this process and settle for a treatment that doesn’t really meet your needs.
• Don’t be afraid to negotiate with your HMO. Even if something isn’t a covered benefit, your HMO might decide to provide it if you can show that you need it and it will save the HMO money in the long run. Your HMO isn’t likely to pay for spa treatments if your argument is that it will save money on anxiety medication. But, it might spring for orthotic shoe inserts if you can show the orthotics have a good chance of preventing or delaying the need for expensive foot surgery, for example. Make your case to your Primary Care Physician and get his or her advice and assistance in negotiating with the HMO.
• Make sure you understand how your HMO works. You won’t be able to get the most from your HMO if you don’t understand the ins and outs of how it works. Worse, you could even make expensive mistakes.
• Advocate for yourself. The single most important thing you can do to get the most from your HMO, or from any other type of health insurance, is to become an empowered patient. Advocating for yourself will help you get best quality care and have the best possible health care outcomes. Learn what this is and how to do it from Trisha Torrey, the expert at About.com’s Patient Empowerment site.