Health & Medical Health News & Knowledge

A Guide To Understanding Your Ppo And Hmo Plan

What is different between the two plans? The PPO plan gives you the option to visit any provider in or out of your network. You will get the most coverage if you visit an in-network doctor because your insurance company has a contractual agreement with these providers to pay them at a rate. This reduces you and your health insurance total expenses. If you have personal preference and decide to visit an out-of-network doctor, you may have a higher deductible (the amount you must pay before coverage can start) as well as out of pocket expense (the amount you owe after your insurance paid their portion). Another aspect you should consider when visiting an out-of-network provider is some services may not be covered. That is why it is important that you call your health insurance plan before seeking care.

The HMO plan is also known as a managed care plan. If you are on this plan, you are either assigned or you choose one doctor as your primary care physician. This doctor will help you monitor your health, and refer you to a specialist if needed. For this plan, you cannot see a specialist unless you have a referral. Specialist care without a referral will not be covered by your insurance company. In some cases, you will need to wait longer for an appointment as opposed to the PPO plan, depending on the volume of patients. This is the way that HMO can limit your choices.

Hopefully, the information in this article will help you decide which plan is best for you.

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