In order to prepare for the Healthcare Open Enrollment period in November, it's important to understand the basics of choosing a Healthcare plan.
Before you begin combing through plan after plan, you need to understand the differences between the two major health insurance plan types in the United States. You can choose between a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) type of plan.
Here are 3 elements that need to be considered when choosing the type of health insurance plan.
HMO vs PPO
Deductible and Premium
One of the factors you'll need to consider when choosing the type of health insurance that's right for you, is the amount you're comfortable paying to meet your deductible.
PPO plans will have a higher premium and deductible. These plans are usually more comprehensive and are designed to give you more flexibility over your health decisions. HMO plans are typically less expensive than PPO plans but have a smaller, closed network of doctors, providers and facilities that you must use for medical services.
If you choose an HMO plan, then your plan will only cover doctors that are in-network. Under an HMO plan, if you decide to visit a doctor that is out-of-network, then you will have to pay for the entire medical bill.
When it comes to a PPO plan, they too have a list of in-network providers, which will lower the amount you're required to pay when visiting an in-network doctor. However, a PPO plan will also pay a portion of your expenses, if you visit an out-of-network doctor.
Choosing a Specialist
When you choose an HMO plan, you're required to find a Primary Care Physician that's in-network. The doctor you choose has significant control over your medical options. Before you can visit a specialist for a specific condition, you're required to visit with your Primary Care Physician and you can only uses the specialist that he refers. The one advantage is the connection between the Primary Care Physician and the specialist will usually result in a reduction in cost for the insured.
PPO plans allow you to consult with any specialist (regardless if it's in or out-of-network) without receiving consent from a Primary Care Physician.
These are the three main considerations that you need to consider when choosing the type of healthcare plan that's right for you.
If you'd like to know more about the differences between a PPO or an HMO healthcare plan, please contact Health Agent Dawn Moore