About HMOs

HMO - Health Maintenance Organizations

Choosing an HMO usually means that you agree to use a specific team of health care professionals. In most cases you select one doctor, from a list of the members, who will serve as your Primary Care Physician. This physician now coordinates all of your health care, which means that he or she treats you directly and, when necessary, manages your referral to specialists. The only exceptions to first going to your Primary Care Physician is for visits to an OB/GYN or in an emergency.

Primarily the highlights of HMO insurance include:
-Lower out-of-pocket expenses.
-No deductibles or plan limits.
-Low cost doctor office visit co-pays of $5-$15.
-Usually no or very low hospital deductibles.
-No paperwork or claim forms.
-Pre-existing conditions may be covered.
-More comprehensive coverage.
-Limited choices of doctors and facilities.
-If you were to travel out of state, you are covered for
emergencies as if you were in the network.


How does it compare to a PPO?


PPO - Preferred Provider Organization

Choosing a PPO in most cases means having the ability to use any doctor or facility you choose, although the benefits are higher when you use one of the physicians or facilities that belong to the chosen PPO organization. All doctors and hospitals within a PPO network have agreed to accept a discounted fee for their services from the plan.

Primarily the highlights of PPO insurance include:
-You may go to any doctor in the network at any time without a referral, including all specialists.
-A co-pay at the doctor's office of $10 - $45.
-You may go out-of-network "at will" to any top specialist for your serious problems.
-No claim forms or paperwork
-Choice of deductible.
-Prescription coverage is included.

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