subject: Knowing about Health Insurance Networks: HMO and PPO [print this page] Knowing about Health Insurance Networks: HMO and PPO
What according to you is the best health insurance policy? Just ask your health care provider to get the answer. But how do you reach them and what plans you can expect from them? Have you ever come across a situation of choosing between the duos?
In the United States Health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are the two major networks of health care providers. Here is a quick introduction to both of these service providers, a brief about their differences and some tips to choose them as well.
What is HMO?
This is a health insurance plan where the policy member needs to choose a primary care physician from the available HMO member physicians. The idea is to appoint a person who will take care of all your general medical care. Before you visit a specialist (also a part of HMO ), you need to consult with your HMO.
How to deal with HMO: Advantages and Disadvantages
If you choose to be a HMO member you do not have an individual or family deductible to meet. Just pay a nominal co-payment to HMO member physicians for each visit. This includes hospital stays even. Such family health insurance plan is advantageous when you run short of liquid cash. Moreover, there are no deductibles and co-payments are comparatively lower.
Of course, there are limitations too. In a HMO plan, you can choose a primary care physician among the HMO member physicians only. If you take health care services from non-networked physicians, no coverage will be given to you. Only in some cases, when you are traveling away from your place and emergency care is needed; you can get the payment coverage.
What is PPO?
Another type of health insurance plan, where you can chose either a general practitioner or a medical specialist of your choice. And, you don't need any referral from primary care physicians for this. The health care service is much similar to HMOs only with the difference that PPO members are independent in choosing their preferred doctor.
How to deal with PPO: Advantages and disadvantages:
Do you have strong preference for a particular doctor? Is it because, you are worried about hospital care and surgery options? Don't get it wrong. If you don't have one preferred physician, PPO membership can benefit you a lot.
Moreover, you don't need to be restricted with in the PPO network for care. However, it is always advantageous to be within the network, since you can save 90% of the health care cost. If you use not-network care, only 50-70% of the costs can be recovered. If hospital care and surgery is the biggest concern, a PPO doctor can easily guide you for that.
The only shortcoming is the pricing part. PPO members need to meet a deductible specially when hospitalized. It does have larger co-payments than HMO as well.
However, both HMO and PPO offer excellent health care solutions to top level professionals. So, which one to choose? It is up to you to decide the optimum one. If you get a chance to select between the duos, take time to evaluate their coverage pattern. Identify which one suits you and your family the best. Maintain this formula for both life and health insurance schemes.
welcome to Insurances.net (https://www.insurances.net)
