HMO's vs. PPO's
Whether through your employer or self employment health insurance, most insured people are enrolled in some sort of managed health care plans. The most common are HMO's, which stands for health maintenance organizations. The PPO plan which stands for preferred provider organization. The less common plan is the POS, which means points of service and plans that combine the features of an HMO and a PPO.
Managed care networks make contracts to obtain lower costs with doctors, health care providers like labs, pharmacies, x-ray centers and medical equipment vendors. They also contract with hospitals and clinics. This group of providers is called the network.
Depending on your insurance you may have to go to someone within the network and not be able to go out of the network. Other plans allow you to go out of the network but you pay more out of pocket expenses.
If you have an HMO, this means you will receive your medical care from providers in the network. You also will have to select a primary care physician who coordinates and manages all your health care.
Your primary care doctor provides all the basic medical services you need. You can select your primary care doctor from a list provided by the insurance company.
If you need an x-ray or lab work, the primary care doctor writes a referral for you to go get that.
PPO's on the other hand, don't require you to select a primary care doctor and you don't need a referral to go to a specialist. You do have a list of preferred providers in the network and these are the ones you can choose from. It will cost you less if you stay in the network.
If you get your care from a doctor in the preferred network then you are only responsible for your annual deductible and a co-pay for the visit. If you go out of the network then like an HMO, your co-pay is higher. In these type instances, you have to pay the doctor directly and then file a claim with your insurance company to get reimbursed.
You should weigh your options of both plans before deciding. Ask for the list of providers and see how many of your doctors are on each plan. www.getinsurancefast.com can help you through this process.