When going back and fourth between if an HMO or PPO plan would be a better fit, a few things you should think of which can help make your decision. When speaking with my clients many are very unclear of the difference between the two kinds of plans.
1. Is My doctor In-Network?
If you have a doctor you can’t live without, you need to make sure before signing up for a HMO plan that your doctor accepts your plan. A doctor may accept your Health Insurance Carrier but not all plans. If your doctor is not a part of your HMO, your insurance will not pay for any of your service.
2. Does HMO Monthly way out the CO-Pays?
HMO plans for individuals are much more expensive then PPO plans but the CO-Pays and CO-Pay limits are a lot less then PPO plans. I would take look at your past few years, how often you used your insurance see if the HMO plans monthly makes sense for your usage. For example, If you are some who uses a lot of office visits it would be great to have $20 CO-Pays vs. 30% on a PPO plan.
3. Do I need to meet a Deductible?
The more new HMO plans that come out the more choices there are. There used to be very few HMO plans that had any kind of deductibles but that is not the case anymore. You need to make sure you how your deductible works, if you get office visits before it is met and what it applies to.
4. What my PCP is for:
You may hear with “PCP” when people speak of HMO plans. A PCP is your Primary Care Physician. A Primary Care Physician is who an HMO member goes to when they need any kind of treatment, referral etc. You will need to go to your Primary Care Physician before you can see any kind of specialist or other doctor. Your PCP will be the person in charge of giving you referrals to see other doctors when you need to. Most Insurance Carriers will allow you change your PCP throughout the year but you need to keep in mind the change will affect the 1st of the next month.
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