Did you realize that over 130 million Americans suffer from some type of chronic disease? Dealing with the effects that disease can have on your body and your finances is no easy task, and can be difficult to work through. The worst thing you can do when trying to beat a chronic health issue is to sink deep in debt due to a lack of insurance. 

Rather than taking on the financial burden of paying for life-saving treatments on your own, you need to find a health insurance plan that is affordable. Not only should it be affordable, but it should also match up with your needs to provide the best benefits possible.

As you start to look at health insurance options for your family, you will be confronted with both HMO and PPO plan options. These are among the most common types of healthcare plans and millions enroll in them annually. Knowing the difference between an HMO and a PPO is essential when trying to make the right decision. Here are some of the things you need to know about these health insurance options.

Getting to Know the Pros and Cons of an HMO Health Plan

Health maintenance organizations (HMO) provide insurance through a network of pre-approved doctors, hospitals and other healthcare providers. The organizations in an HMO’s network all agree to accept the costs and the payment terms established by this organization. This will get you reduced rates for many of your most common healthcare needs. It is affordable for many people, and it is one of the best options on the market. An HMO has a number of pros and cons which we will cover below.

Having a Primary Care Physician is Beneficial

One of the first things you will do when signing up for an HMO insurance plan is to select a primary care physician from their network. If you already have a trusted physician you visit on a regular basis, you need to make sure they are on this list before signing off on a new HMO plan.

Some people prefer choosing a primary care physician from the list of pre-approved options in an HMO network if you don’t already have one or are looking to switch. Having a primary care doctor will allow you to have a central point of care option for any ailments you face. This PCP will also be the one who refers you to specialists if you require them.

There are Restrictions For Out of Network Care

Getting the best possible medical care is essential when trying to battle a serious illness. Having the restrictions of an HMO network can get in the way of your treatments. If you have to go out of your pre-approved network to get the care you need, it can lead to a lot of out of pocket expenses. Also, as briefly touched on before, you may require referrals if you want to meet with specialists. This can extend the process and take more time, unfortunately.

In most cases, you will be responsible for most of the costs associated with going to an out of network doctor or medical facility. Assessing how much a particular HMO will pay for out of network expenses is important before deciding to sign up for a plan. Knowing this information can help you save a lot of money in the future.

The Ins and Outs of a PPO Health Plan

Now that you know about some of the pros and cons of HMO health plans, we will discuss the ins and outs of health insurance offered by preferred provider organizations (PPO). Unlike a HMO, a PPO doesn’t limit you to healthcare providers who are only in your network, and are often more flexible as a result.

This type of health plan also has a variety of pros and cons you need to know about, as wekk. The more you know about the details of a PPO, the easier it will be to choose a great option for you and your family.

Very Lax Referral Requirements

For most people, choosing a PPO health plan is mostly about lax referral requirements. A number of health insurance providers require their customers to get a referral from their primary care doctor before they can see a specialist for an ailment they are dealing with. This process can be both time-consuming and frustrating.

With a PPO health plan, you can avoid extra office visits and co-pays with their no referral policy. In some cases, you will be able to get in to see a specialist quickly if the ailment you are dealing with is deemed urgent or severe. Now, this added flexibility comes with a cost. These plans often have higher monthly payments, but many feel that these higher costs are more than worth it.

Also, when you travel with an HMO, there is a chance you will not be covered everywhere you go. This could lead to inflated costs that you weren’t expecting, which aren’t always easy to recover from. Thankfully, PPOs allow you to receive care wherever you are.

PPO Health Plans Have In-Network Limitations

Perhaps the most common complaints people have about their PPO health insurance plan is the in-network limitations. HMO plans tend to have a larger network of pre-approved doctors and healthcare organizations to choose from.

This means you will often have a larger choice of people you can visit and get reduced rates. If you have a number of ailments you need to be treated for, then a PPO plan may not be a great option. 

The Right Plan is Out There

Taking your time and researching all of your health insurance options is important. With this information, you can find the plan that best fits your needs. Whether it be a PPO, HMO or another plan entirely, we hope this article has helped make your decision and choice a little bit easier.

About the author

Lauren LaPorte

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