Finding The Best Solution
Different families have different needs. When it comes to health insurance, you’ve got to be quite careful. There are a lot of solutions out there, and some are going to work better for you. For the moment, we’ll avoid discussing options like Medi-Share which exist beyond the mainstream. These can be cost-effective and representative, but may not be right for you.
It all depends on the specific needs surrounding your situation. Most people end up choosing between an HMO plan and a PPO plan. Following we’ll help you understand what differentiates these healthcare options, and which might best serve you.
What Is HMO, What Is PPO?
HMO stands for Health Maintenance Organization. With an HMO, you’ll have access to doctors as well as medical facilities that exist within a given network. Said network will be composed of varying providers that have an agreement.
Essentially, plan members get a reduced rate without a reduction in associated standards of medical quality. Here’s the thing: you only get coverage within your network.
PPO stands for Preferred Provider Organization. A PPO plan is generally going to extend you greater flexibility in determining who your best doctor or medical institution is. There’s an available network of providers as in an HMO, and you can expect a reduction in overall restrictions.
HMO Pros And Cons
While there are some HMO situations where a provider that you find beyond your network may be covered, such occasions are rare; and if they’re available, strict restrictions silhouette them. You might only get a few treatments, visitation to a provider is apt to be limited, and only some tests will be covered—out of your network, that is.
HMO plans have a diversity about them which means not all of them are exactly the same. You may have to find a specific PCP (Primary Care Physician). If there’s some specialist required for your healthcare, that PCP may be required to issue a formal recommendation.
That said, the silver lining is that you can expect either no deductible, or a low one. Also, overall costs for HMOs tend to be less expensive. Lastly, it’s notable that certain HMO plans do not require a PCP for specialists to see you. It depends on the HMO provider and your network; so do your homework and conduct a little research.
Pros And Cons Of PPO
With PPO, if you do see a healthcare provider that is not part of your network, you’re going to retain your coverage. The coverage may not be quite as good, but you won’t be left “out to dry”, as the saying goes. No PCP is required for reasons of specialist authorization; you can just go with who you think is most appropriate.
This can be a very big advantage. The next couple of facts represent an unpopular sentiment, but one that you should think about. Doctors and medical professionals are exceptionally well-educated and generally know more than you do—but they’re just people, and they make mistakes.
Something like 250k people die in America every year owing to medical malpractice—depending on your source; there is some controversy. Here’s a page from a legal website to help you understand what’s going on. Generally this isn’t malicious; it’s accidental. Sometimes it has to do with poor procedures. A doctor is part of a profession that has had to reverse-engineer human biology without any blueprint from which to proceed.
The term “body mechanic” is really not that far off. Accordingly, healthcare professionals generally know more than you, but they’re not perfect. It’s wise to choose your healthcare provider carefully. HMOs will limit your options, PPOs will expand them. You can definitely get help outside your network. However, you’re likely going to pay more for PPO coverage, and there is commonly a deductible.
Rounding Out Your Decision With Proper Information
So though on the one hand there are clear advantages to a PPO option, on the other there are increased expenses. If you’ve got an HMO in a network with people who have trusted expertise, that may be the better option. But if you commonly travel outside the network, it can be wise to go with a PPO option.
What’s necessary is determining your true needs. You will want to do your research, and inform that research with clear consultation through trusted professional resources. Check out the following link for more information on the difference between an HMO and a PPO plan. This will help you see which benefits you the most.
Sometimes your employer may offer coverage under HMO or PPO. Research to see what kind of package is available, and what its cost is. Different networks are going to have different positives and negatives that recommend them. If you’re going to get the best option, you’re going to have to shop around a little.
So in a nutshell, the HMO option is cheaper but more restricted. Meanwhile the PPO option is more costly, but less restricted. In either scenario, going outside your network will generally end up being a costlier proposition than staying within it. Your best bet is doing all that’s possible in your power to stay as healthy as you can, and keep your family healthy. It’s better to have healthcare and not need it than need it and not have it; staying healthy will save you the most trouble.