Insurance question? What is the difference between HMO & PPO Health plans?
Question:
Answer:
A Health Maintenance Organization (HMO) allows you to see a regular Dr. with in the network for free or a very reduced cost. You have to have a referral to a specialist and may not be able to be seen as soon as you need to. You cannot choose your own specialist In special needs situations you can appeal to your HMO to cover something that is out of bounds. This might be to a specialist hospital like a transplant or heart surgery (big things). Your HMO may have an affiliation with theses places.
A PPO (preferred providers organization) has Dr.s that they prefer you see, you can self refer to a specialist with out your primary Dr. authorizing it, They generally have a small co pay and a little larger co pay for specialists. If you chose an out of network physician it will be covered under the contract you have. In network I have 90/10 insurance (they pay 90% , Ipay 10) If I chose to go out of network I have a 70/30 coverage. I have had Dr's that are not in network that will sign a contract to be in network for just me so I get the 90/10.
I've had both, I like PPO better.
A PPO is a specific doctor you pick and that is who you have to see, unless referred by him to see someone else
I have found that they all differ from company to company. One time I was convinced I would alway's pick PPO, then the next year, with the same company, the HMO was a better deal for us. Just like the PPO the year before. I think they do stuff like that to confuse us even more! So really, you just have to read the fine print. Alot of reading but you must do it. Usually, there is a page in the book that has the two together, and shows the differences between the two and you can pick from that which would better suit your needs.
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