Wednesday, July 22, 2015

What You Should Know About HMO And PPO Group Health Plan Options

June 26, 2011 by  
Filed under Health & Wellness

Health insurance policies are available for individuals and families but there are so many variations that it gets confusing. Being able to find a Colorado health insurance company that makes sense and fits your budget means you’ll want to be a part of a group plan, but since there are a couple of different types of group policies, understanding which will be the best for your needs is important.

While HMO’s (Health Maintenance Organizations) and PPO’s (Preferred Provider Organizations) have a few similarities, it’s the differences that have to be taken into consideration. As similarities go you can expect to have the Colorado health insurance company paying a percentage of the medical bills and you’ll always have a monthly premium to pay. Other than that, there are few other similarities of any consequence. It’s the differences you’ll need to play close attention to.

An HMO is designed to be a “single point” approach to health care. You’ll select a primary care physician (PCP) in the network of doctors in the organization as well as primary care physicians for the other members of your family. These PCP’s will manage your entire health care platform including making referrals to specialists and other doctors as needed. You’ll have to have a referral from your PCP in order for the insurance to be applied correctly. If you have to see a physician outside of the network, you’ll probably be responsible for all or most of the bill.

A PPO is a Colorado health insurance plan that contracts with a network of “preferred providers” from which you can choose any doctor you want. You’re not limited by having to select a PCP and won’t have to have a referral in order to see other doctors in the PPO network. As long as you see in-network doctors, you’ll only have to meet your annual deductible and pay co-payments as the insurance will take care of the rest.

HMO’s pay when the in-network doctors file Colorado health insurance claims which means you’re not responsible for any additional paperwork. However, if you have to use a doctor or facility that you’ve not been referred to, especially ones out of network, HMO’s generally won’t pay for them. As it stands, you’ll still have co-pays for in-network visits and medicines.

With PPO’s however, if you had to go to an out of network provider, you’ll be responsible for covering the bill and will have to file a claim with the PPO to be reimbursed. Also, regardless of whether you have to see in-network doctors or out of network ones, you’ll have an annual deductible that will have to be met before the Colorado health insurance will kick in and pay a percentage of the bill. The best thing to do is to sit down and talk to health insurance agents and do some research to see which type of group plan will meet your needs and so you’ll know what your ultimate costs will be.

Doing your research is key when choosing which employer group health insurance option is best for you and your family. Royce Vangoff changed his Colorado health insurance when he found a plan that worked better for him.

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