HMO’s and PPO’s are the two most common types of plans offered by insurance carriers. You have probably had to make the decision between these two types of plans in the past. Generally speaking, PPO’s offer more flexibility in the doctor or hospital you use, but come with higher costs. In today’s video we’re going to break down some of the general differences. However, it really does depend upon your specific carrier and plan. We’ll also discuss why you may favor one type of plan over another dependent upon your specific needs.
Should you need any assistance choosing between plans, please feel free to contact us here at iHealthBrokers are 888-410-0344. We are licensed in all 50 states and with over 200 carriers, so no matter where you are, we can help. Our services are 100% free.
HMO vs PPO
Premiums
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
PCP
With most HMO plans, all of your healthcare services are coordinated by your designated PCP (primary care physician). PPO plans do not require PCPs or referrals for any services.
Referrals for Specialists
With an HMO, you must first schedule an appointment with your PCP and he or she will provide a referral to an in-network specialist. PPO plans do not require referrals for any services.
Out of Network Coverage
HMOs don’t offer coverage for care from out-of-network healthcare providers. The only exception is for true medical emergencies. With a PPO, you have the flexibility to visit providers outside of your network. However, visiting an out-of-network provider will include a higher fee and a separate deductible.
Filing Claims
Since HMOs only allow you to visit in-network providers, it’s likely you’ll never have to file a claim. This is because your insurance company pays the provider directly. With PPO’s, in some cases, you will have to pay a doctor for services directly and then file a claim to get reimbursed. This is most common when you seek services from out-of-network providers.
Which is the best type of insurance plan? What insurance is better for me?
Ultimately, the decision to opt for a PPO vs. HMO or vice versa is a very personal one. It boils down to cost vs. convenience. HMO’s offer lower premiums and usually lower copays. Make sure to compare premiums and copays when considering your decision. However, the cost saving benefits of an HMO end if you need to see an out of network doctor.
Do you currently utilize multiple specialists? If so, you may want to stick with a PPO. PPO’s will allow you so visit out of network doctors and still have a portion of the cost covered. How much of that cost will be covered is determined by your specific plan and carrier. Weigh those costs with the difference in cost between the plans’ monthly premiums and copays. Additionally, with an HMO you’ll need to see your PCP for a referral so that means one more visit, one more day off work, and one more copay. And make sure that the specialist that your PCP recommends is in network or you’ll be on the hook for those full costs!
Additionally, you may be able to apply for a gap exception. With an HMO, if you need to see a specialist but there are none in your network covered in your geographical area, you may be able to apply for a gap exception and be reimbursed for a portion of the costs by your insurance company. BUT, the process can be long and difficult.
If you have any questions, please leave a comment so we can help our call us at (888) 410-0344 At iHealthBrokers we are licensed nationwide and our services are 100% FREE!
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