HMO and PPO Networks

Different Kinds of Networks- HMO and PPO Networks

In the wonderful world of health insurance, thousands of plans are available to fit your health care needs. They vary in many different ways. In addition, these plans are categorized into different networks. The networks have vast differences. Some of the main differences being costs and overall coverage. If you're not aware of the network your plan falls under, you can find yourself not being able to receive the necessary care in a bad health situation. The most prevalent networks are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Hopefully, this will educate you and clearly show the pros and cons of HMO and PPO networks.

HMO Networks

With an HMO, you have access to certain doctors and hospitals within its network. But care under an HMO plan is covered only if you see a provider within that HMO's network. That brings notice to the first con of HMO plans. Coverage is restricted pretty heavily. HMO plans even restrict number of visits to doctors, tests, or treatments. For example, with some of the current HMO plans offered in Kansas, Children's Mercy Hospital and KU Medical Center are not covered. In addition, you only have a few hospitals in the state that are in network.

So, let's use the example of going on a fishing trip in Minnesota for a moment. Now, let's say you're walking around a lake finding the spot you'd like to fish at and you fall and break your ankle. Under those HMO plans, you would have to fly back to your home city to go to one of the few covered hospitals that are in network, versus receiving care in Minnesota.

Now, I'd like to outline some other key points about HMO's, both good and bad. Some HMO plans may require you to select a Primary Care Physician, who determines what treatment you need and will receive. With certain plans, you may need that Primary Care Physician's referral to be covered when you see a specialist or have tests done. If you opt to use a doctor outside of the network, there is no coverage offered at all. That means you front the entire cost of the medical services provided. Lastly, premiums are generally lower for HMO plans, and there can be no deductible or a low one. As you can see, the low costs are in direct correlation to the restricted coverage.

PPO Networks

PPO networks tend to have the upper hand when it comes to providing adequate coverage. They are more flexible regarding which hospital, doctor, treatment, or test you can access. The networks also provide access and coverage when seeing non-network providers. In most cases, your PPO insurance will pay if you see a non-network provider, even if it's at a lower rate.

Some of the pros that go hand in hand with PPO networks outline its superiority. First, you can see a doctor or specialist of your choice without having to consult with your Primary Care Physician first. Also, you can venture outside of the network for coverage, although the benefits might be better if you stay in the network. The only con is the costs. But like HMO networks, the higher costs typically are in direct correlation to the available benefits. Premiums tend to be higher, and there is usually a deductible. With PPO networks, you typically pay for better health care and coverage.

Why It's Good To Know The Differences Between HMO and PPO Networks

Many recent developments in healthcare have led for your need to be educated more thoroughly on the subject. A handful of carriers have begun decreasing coverage and raising rates. For instance, Aetna have begun to transition group plans from PPO to HMO plans. Also, Blue Cross Blue Shield has begun to cancel grandfathered-in group plans. Blue Cross Blue Shield of Kansas will still have a PPO option but the individual plans have all transitioned to HMO. With this transition, you pay just as much if not more for each of the restrictions listed above.

How Apollo Can Help You

Apollo Insurance Group has access to a variety of carriers and plans, both ACA compliant and exempt. With the outstanding training and knowledge we have bestowed upon our agents, they have the upper hand in dealing with your healthcare necessities. We also pride ourselves in our customer relations and competitive plans. At Apollo, we scour the plans offered in the marketplace to find one that fits you perfectly. Our goal is to attain the best coverage for you that doesn't burn a hole in your pocket. So, if you're frustrated with your current healthcare expenses and/or coverage, or have more questions about HMO and PPO Networks,  please contact us today!

 

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