Main Features of HMO and PPO Insurance Plans

In America, it does not matter if you are self-insured or it was your employer who provided you with health insurance because in both cases, most people are enrolled in the insurance plans of either a health maintenance organization (HMO) or a preferred provider organization (PPO). a group of people smilingThere are also point-of-service (POS) plans that are a sort of combination of the HMO and PPO’s main features, but they are not widely used by Americans. With no exceptions, the first two managed care programs conclude contracts with doctors of different specializations, hospitals and clinics, and such health care facilities as drugstores, laboratories, etc. These providers of medical care are united in one group that is known as the network of the insurance plan. Although these two plans fall within the boundaries of affordable health insurance Arizona that people are so used to, they differ in performance and in some cases, may involve additional expenses. If you have not still chosen a plan that will best meet your requirements, herein is a brief comparison of the HMO and PPO plans.

 What HMO Insurance May Give You

HMO involves receiving all health care services only from a provider within their network. When enrolling in their insurance plan, you will have to choose one primary care physician (PCP) that will fully control your treatment. This means that if you already have your current physician, he/she will have to be replaced by a network-provided professional, or you will have to pay in full for his/her services. Moreover, you will not be able to visit other doctors without a referral from your PCP. So, if you have a rash, you should go to your physician first, but not a dermatologist, like people usually do.

 How It Differs from a PPO Plan?

If you choose a PPO insurance plan, you will not be stick to one physician and will be free to visit any doctor that you need from the list of “preferred” providers without any referrals. Moreover, you may ask for help any doctor that is not a part of the network. Although you will have to pay more for his/her services, unlike HMOs that do not cover “out-of-network” visits at all, PPOs still reimburse them partly after you file an insurance claim.

 How Do I Pay?

All the HMO and PPO insurance plans charge monthly premiums and co-payments for doctors’ consultations and procedures that patients undergo. However, HMO’s payments are much lower than PPO’s are. Note also that most PPO plans involve additional annual deductibles.

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Posted by on Oct 9 2013. Filed under Insurance. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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