HMO & PPO PLANS
BALANCING YOUR NEEDS
HMO, PPO, Health Insurance
HMO and PPO plans develop from balancing financial
and service options. The more expensive plans can vary in their features,
i.e. a higher priced plan can mean more services are covered. It can mean
that the plan pays a larger portion of the cost for covered services. It
can also mean that deductibles and out-of-pocket maximums are more favorable
to you.
CPB Health helps you sort through all the variables and know just what is
most important to you.
HMO - Health Maintenance
Organizations
HMO, PPO, Health InsuranceChoosing an HMO usually means that you agree to
use a specific team of health care professionals. In most cases you select
one doctor, from a list of the members, who will serve as your Primary Care
Physician. This physician now coordinates all of your health care, which
means that he or she treats you directly and, when necessary, manages your
referral to specialists. The only exceptions to first going to your Primary
Care Physician is for visits to an OB/GYN or in an emergency.
Some HMO's are becoming more flexible with the above structure and CPB Health
is happy to educate you on the variations that can make the difference in
your choice of HMO health insurance.
Primarily the highlights of HMO insurance include:
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Lower out-of-pocket expenses
-
No deductibles or plan limits
-
Low cost doctor office visit co-pays of
$5-$15
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Usually no or very low hospital deductibles
-
No paperwork or claim forms
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Pre-existing conditions may be covered
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More comprehensive coverage
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Limited choices of doctors and facilities
-
If you were to travel out of state, you are covered
for emergencies as if you were in the network.
PPO - Preferred Provider
Organization
HMO, PPO, Health InsuranceChoosing a PPO in most
cases means having the ability to use any doctor or facility you choose,
although the benefits are higher when you use one of the physicians or facilities
that belong to the chosen PPO organization. All doctors and hospitals within
a PPO network have agreed to accept a discounted fee for their services from
the plan.
It is possible to find, from some providers, a broad range of available
individualized choices within the above framework. It is important to know
all your options before signing for your future medical protection and CPB
Health is here to assist.
Primarily the highlights of PPO insurance include:
-
You may go to any doctor in the network at any
time without a referral, including all specialists
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A co-pay at the doctor's office of $10 - $45
-
You may go out-of-network "at will" to any top
specialist for your serious problems
-
No claim forms or paperwork
-
Choice of deductible
-
Prescription coverage is included
There Is Much To Consider
The choices are many. One must take the
responsibility to know what needs are required, what needs may be required,
what financial considerations exist, and which health insurance options are
best suited for all of the above HMO vs. PPO discussions.
CPB Health will guide you through it all. Simply contact us and we will be
pleased to assist you in identifying the best product for your medical and
financial security.
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