If you’re looking into purchasing a health insurance policy, you might find yourself faced with a choice between a HMO or a PPO. This could be a difficult choice, especially for those with little experience with health insurance. How do you determine which type of policy will best suit your needs and provide you with the coverage you need? Which will give you options and affordability without sacrificing healthcare quality?
HMOs
A HMO (health maintenance organization) is a great health insurance option. Some people like them, some don’t. It’s a matter of personal opinion. It’s not advisable to choose your health insurance based on the fact that your friend or a family member has told you they don’t care for a certain company or option. It is better to look into the choices yourself, and decide which best fits your own particular needs and leave it at that. If ever you become dissatisfied, you can always make a change later.
When you choose a HMO, you will be given a list of network providers and will choose a primary care physician from among them. The PCP will then handle all of your basic medical care. Should you ever need specialized care or medical services, your PCP will then provide you with a referral to another physician within the network for this purpose. The only exception is in emergency situations.
All insurance claims will be filed by your healthcare provider, so you do not have to worry about that.
With an HMO, you will only be responsible for out-of-pocket expenses in the form of co-payments for doctor visits, prescriptions, procedures and a few other things that might require a patient co-pay. However, these expenses are minimal compared to paying every single medical expense out of your own pocket.
PPOs
A PPO (preferred provider organization) also has a list of network providers, however, you can also choose out-of-network physicians. You will simply pay a little bit more out-of-pocket. You also do not have to select and maintain a primary care physician, nor will you need a referral for the services of any doctor, regardless of your medical needs. The catch is that some specialists will require a referral anyway before they will see you. In that case, just drop in to see a family physician, and get yourself a referral or search for a specialist who will see you without it. PPOs will also sometimes require prior approval for certain tests and procedures, such as MRIs. For the most part, your healthcare provider will file the insurance claims. However, if you choose an out-of-network doctor, you may have to pay out-of-pocket and file a claim for reimbursement with your PPO. Aside from this possible expense, you will only have to worry about paying a co-payment, the same as with a HMO. However, some PPO plans do have an annual deductible, meaning you will have to pay a set amount out of pocket before your coverage kicks in and then you would be responsible for a percentage after that. Be sure to read the fine print or search for a PPO without the deductible if this is something you wish to avoid.
Your Choice
Either way you choose to go, both HMOs and PPOs are great choices for health insurance. It’s simply a matter of your healthcare needs, preferences, and, of course, your budget. PPOs offer the greatest flexibility and are really an excellent choice for those who do not need to see a doctor on a regular basis. HMOs are a great choice for those who need to see a doctor often and those who prefer the familiarity of the same providers handling their care. It’s always best to shop around and get all the information and a few solid quotes before you make a decision.
