Never fear, all health plans are the same and all providers are the same. Just pick one at random and all will be well! Luckily, most people do not actually believe this statement and they understand that they should be well educated about the options available to them. Two of the major options available today are HMOs and PPOs. What are they and which one is best? For answers, I checked out insurance.com. What is the most interesting is that the major differences are in the organizational structure of the plans, but the customer sees very little difference from their end.
The HMO (Health Maintenance Organization) asks customers to choose a primary care provider from a list of approved providers that the HMO gives them. In the HMO, for a customer to see a specialist, the primary provider has to refer them. This is the first difference for customers. In a PPO, the customer can actually refer themselves to a specialist and don’t have to stick to one primary provider.
HMOs take good care of those providers in their network by not paying for any care received by a customer from someone outside the network. PPO’s on the other hand just give some serious financial motivation to stay with recommended providers. For example, a PPO pays for a major percentage of care received by network providers, but they will pay for a lot less of the care received by those outside the network.
A final customer-end difference regards deductibles. HMOs usually don’t have them-they start providing care from visit one! However, PPOs often have a deductible.
So which one is best? That depends on your financial and health situations. The most important thing to do is to shop around and ask around. Talk to people in both kinds of plan to see what their experience has been. You will benefit in the long run from the leg work you do before beginning coverage.