For a full understanding of your health insurance options, you need to know more about HMO, PPO, and other types of healthcare plans. HMOs and PPOs have different features and benefits, so learning more can help you feel confident about your choices. Though all of the options may feel intimidating, you don’t have to figure it all out on your own.
HMO and PPO FAQ
HealthMarkets Insurance Agency understands unique insurance needs and has a portfolio of products from more than 140 national and regional insurance companies to help meet your needs. We can help you find the best insurance plan for your situation. What are the basics of HMOs? HMO stands for Health Maintenance Organization, and HMO plans are designed to help cover medical expenses by subscribers who receive care within a certain network. Here’s how it works:
- You choose a primary doctor from a network of providers.
- Your primary doctor refers you to in-network specialists as needed.
- You pay a set co-pay each time you see network a doctor.
- You won’t receive coverage for out-of-network care, except for emergency situations.
What are the basics of PPOs? PPO stands for Preferred Provider Organization. This type of plan allows you to seek medical services from both in-network and out-of-network providers. Here’s how a PPO differs from an HMO plan:
- You do not need to choose a primary doctor.
- You can see any doctor within the network, without referral, and pay a discounted rate.
- You may also see an out-of-network doctor and pay a higher rate, but still get some coverage.
How do you compare HMO, PPO and other options? How you compare your health insurance options depends on what you want. While HMOs offer less flexibility and freedom, they may also have fewer out-of-pocket costs than PPOs. It may benefit you, depending on your circumstances, to spend a bit more to enjoy the freedom of choosing your own doctor and specialists. If neither of these plans sounds appealing, there are other options, including EPOs (Exclusive Provider Organizations) and POS plans (Point of Service).