Insurance World

Health Maintenance Organizations, also known as HMOs, and Preferred Provider Organizations, also known as PPOs, are just two types of health insurance plans that belong to a larger spectrum of health insurance plans called Managed Care Insurance.

The characteristic that all health insurance plans categorized as managed care insurance have in common is that they provide policy holders with a list of doctors and other health care providers that they would prefer the policy holders to visit when in need of medical attention. The doctors and other health care providers are contracted to work with the health care plan’s network, which means the policy holder will be able to pay less money to visit them that he or she would pay to visit a doctor not on the list, or “out-of-network.”

So, what’s the difference between HMOs and PPOs?

Health Maintenance Organizations, or HMOs, require their policy holders to pay a monthly insurance bill in order to see a doctor or health care provider, regardless of whether or not the policy holder actually seeks medical attention during that month. This may not sound like a very good deal, but HMOs do tend to provide a vast array of medical services for their policy holders under the HMO health insurance plan.

Preferred Provider Organizations, or PPOs, include a network of doctors and other health care providers that cover only a specific group of policy holders, such as the employees of a company. Policy holders pay a co-payment at the time of service, and the rest of the bill is either sent to the insurance company, or paid by the policy holder who is then reimbursed by the insurance company.

Being a policy holder of an HMO or PPO doesn’t always mean you have to see a doctor or other health care provider included in the network. Sometimes HMOs and PPOs allow you to seek out-of-network medical attention at an increased price.

Paying for health care can consume a large portion of an individual or family’s disposable income. Some costs are non-negotiable but there are ways to lower the amount you spend on insuring your health.

Deductibles

You may be able to pay a lower premium by paying a higher deductible. This is particularly true if you are insured as an individual rather than through your employer. If you choose this option it is wise to place a portion of the money saved on your premium into an account which is used solely to pay your deductible.

Co-pay amount

Many companies have lower premium policies available for those willing to make a higher co-payment when they visit the doctor. Opting for a higher co-payment can be especially advantageous for people who don’t often visit the doctor.

Generic drugs

Generic drugs are manufactured to the same standards as brand name drugs. Choosing to have a prescription filled with a generic drug can offer substantial savings over having it filled with a brand name drug.

Healthy living programs

Many insurance plans offer pre-emptive health care services which are entirely funded by the insurance company. Employee plans often do this as a way of avoiding paying for higher priced services later on down the line. Programs may include free immunizations, mammograms, prostate exams and general physicals. Paying a portion of monthly health club dues is also available on a few plans. Be sure to take advantage of these options if possible.

Remember, while health insurance premiums are high the peace of mind brought by knowing you
and your family are insured is priceless. Gathering as many quotes as possible is the best way to learn and compare companies.

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