The Lived Experiences of HMO Individual Cardholders on Healthcare Coverage and Services

( Vol-11,Issue-6,November - December 2025 )

Author(s): Hessah Marjonie E. Zapanta, Renaly C. Rosaria, Joshua Albert S. Gabor, Nathaniel G. Reyes, Lani D. Deada, Marmelo V. Abante

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Page No: 030-061
DOI: 10.22161/ijaems.116.5

Keywords:

Health Maintenance Organization, Healthcare Coverage, Accessibility

Abstract:

This qualitative study explored the lived experiences of Health Maintenance Organization (HMO) individual cardholders regarding the adequacy, accessibility, and inclusivity of their healthcare coverage and services. Using a phenomenological research design, ten participants were interviewed to capture their perceptions and experiences in availing HMO benefits. Findings revealed recurring challenges such as long waiting times, delayed billing and approval processes, and limited availability of accredited healthcare providers. These administrative inefficiencies often resulted in inconvenience, out-of-pocket payments, and decreased satisfaction. Despite these issues, participants expressed generally positive perceptions toward HMO plans, highlighting their affordability, practicality, and financial protection during emergencies. Many recognized improvements in accessibility through digitalized approval systems and more responsive service channels. Overall, the study concludes that while gaps remain in coverage inclusivity and benefit awareness, HMO membership continues to serve as a valuable complement to PhilHealth by providing financial security and promoting greater access to private healthcare services.

Received: 08 Oct 2025; Received in revised form: 06 Nov 2025; Accepted: 11 Nov 2025; Available online: 15 Nov 2025

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