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Saturday, February 9, 2013

PPO or HMO--What to Look for in Affordable Health Insurance

PPO means Preferred Provider Organization, and HMO means Health Maintenance Organization. They both describe two different types of health insurance plans that determine what health care services are included in the plan.

PPO is the most popular because it allows the most freedom to choose any primary physician or health care provider, and no referral is needed in order to see a specialist. The plan offers a list of physicians and health care providers that are preferred by the plan. However, patients may also use their own providers, even if they are not on the preferred list, and still receive health insurance coverage. The difference between the two is the percent of the cost that the plan covers. Costs for providers on the preferred list will generally be covered at a higher percentage than those who are not on the list.

HMO's offer a broader range of services, including more preventative health care. Again, the plan includes a network of providers; however, the difference between this plan and a PPO is that patients need to choose a primary care physician that is in the plan network. In addition, services by health care providers that are not on the list may not be covered at all unless a patient's primary care physician refers them. The benefits of a HMO are lower premiums and more coverage for preventative care like flu shots and visits to the doctor for a medical checkup.

The decision as to what type of plan to choose is based entirely on each individual's and family's  needs and circumstances. Cost is certainly a consideration. However, health needs are also important to include in the decision making. If an individual is healthy with no health issues that require the services of specialists, the HMO might be a good choice. For those who have pre-existing conditions or under the care of a specialist that has been treating them for some time, the PPO might be a better choice.
DISCLAIMER: The content or opinions expressed on this web site are not to be interpreted as medical advice. Please consult with your doctor or medical practictioner before utilizing any suggestions on this web site.