Helpful Tips For Moms: Choosing Between An HMO And PPO Health Plan

As a mom, you want to ensure your children and family have access to the best healthcare possible, if it’s ever needed. Unfortunately, with the high cost of health care services, if you don’t have the right insurance, this is extremely challenging.

While that may be true, there are some policies you can choose from. Getting to know the differences between an HMO and PPO can help you understand what options you have for health coverage. Usually, these are plans you receive through your employer, but if they are still trying to choose a plan, knowing the difference can help ensure you get the one that best suits your needs. Keep reading to see how to compare HMO and PPO plans to find the one that best suits your needs.

Getting to Know HMO Insurance Coverage

HMO means Health Maintenance Organization. It’s an extremely popular type of health insurance designed to offer members an array of healthcare services provided by in-network doctors, healthcare services providers, and hospitals. The providers and hospitals that are part of an HMO have agreed to receive payment for services at a set price, which helps the HMO keep prices lower.

The only time out-of-network services can be used to members (and covered by their HMO) is in emergency situations. With an HMO plan, you are usually required to select a primary care physician (PCP) who is then going to refer their patient to a specialist for services that cost more like an MRI o surgery.

Benefits of Choosing an HMO

Some of the benefits offered by choosing an HMO include:

More Affordable Out-of-Pocket Charges

Regardless of the medical services you need, you pay a set, monthly fee. This is different from other health insurances where you have to pay a percentage of the services provided.

Smaller Co-Pays

Some healthcare providers don’t charge a co-pay, while others may require between $5 and $20 (on average).

No Deductibles to Pay

With an HMO plan, you don’t (usually) have to pay a deductible.

Lower Premiums

An HMO plan will usually require you to pay a lower premium compared to some of the other popular insurance plans available.

Preventative Care Focus

An HMO plan has a higher focus on preventative care and practice wellness, along with preventative medicine. In some situations, you will gain access to free health screenings, health education classes, and receive discounts on health club memberships.

Getting to Know PPO Health Insurance

PPO stands for Preferred Provider Organization. This health plan is one that provides you with a network of providers, which is similar to the HMO. The provider has agreed to provided services at a certain rate.

One of the main differences between the HMO and PPO is that with a PPO you can receive care from any healthcare provider – in or out of network. Additionally, unlike the HMO, if you have a PPO, you don’t have to choose a PCP or receive a referral to go to a specialist.

Benefits of Choosing a PPO

There are several benefits offered when you choose a PPO. These include:

No Referrals Required

With a PPO, you don’t have to get a referral from another doctor to go to a specialist. This usually helps you save money on additional office visits and co-pays.

No Need to File Claims

When you are a PPO health insurance member, you don’t have to file a claim. The providers and the insurer you use has an agreement, and they handle the payment process.

Receive Wider Coverage

A PPO plan is usually going to provide a much wider range of services than an HMO plan will. This plan will usually cover preventative care including checkups and physicals, along with medications, hospitalization, emergency care, specialist treatments, and outpatient surgery.

PPO vs. HMO: Making a Choice

As you can see, there are several options when it comes to health insurance coverage. As a mom, you have more to think about than just yourself, so be sure to consider all the information here carefully. Doing so is going to help you select a health insurance plan that will meet your needs and the needs of your family, now and in the future. 

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