A Guide to Understanding Your PPO and HMO Plan

Understanding your health plan can save you time,should consider when visiting an out-of-network
money and headaches. The two most commonprovider is some services may not be covered.
plans are the Preferred Provider OrganizationsThat is why it is important that you call your
(PPO), and the Health Maintenance Organizationshealth insurance plan before seeking care.
(HMO).The HMO plan is also known as a managed care
What is different between the two plans? Theplan. If you are on this plan, you are either
PPO plan gives you the option to visit anyassigned or you choose one doctor as your
provider in or out of your network. You will getprimary care physician. This doctor will help you
the most coverage if you visit an in-networkmonitor your health, and refer you to a specialist
doctor because your insurance company has aif needed. For this plan, you cannot see a specialist
contractual agreement with these providers tounless you have a referral. Specialist care without
pay them at a rate. This reduces you and youra referral will not be covered by your insurance
health insurance total expenses. If you havecompany. In some cases, you will need to wait
personal preference and decide to visit anlonger for an appointment as opposed to the PPO
out-of-network doctor, you may have a higherplan, depending on the volume of patients. This is
deductible (the amount you must pay beforethe way that HMO can limit your choices.
coverage can start) as well as out of pocketHopefully, the information in this article will help
expense (the amount you owe after youryou decide which plan is best for you.
insurance paid their portion). Another aspect you