The world of insurance is rather confusing and tricky. Hence it is necessary that one thoroughly understand the advantages and drawbacks of different types of health insurance. If your employer has got you insured, you must know whether you wish to have the PPO plan or the HMO plan. There are differences between the two as well as advantages and shortcomings.
What is an HMO?
An HMO, which is also known as Health Maintenance Organization, is a grouping of doctors, hospitals and healthcare clinics that have jointly contracted with an insurance company to present their services for a certain price that needs to be paid. For this reason, HMO plans are usually restraining and have many rules. For instance, you need to choose a primary care physician who is a member of your HMO to administer all facets of your healthcare. If your current doctor is not a part of the HMO network, you could ask him to become a member or else you will have to change physicians to find one that is in the network.
Another limitation that might occur is that if you are presently seeing a specialist, you will need to first see your primary care physician to attain a recommendation. That specialist particularly should be a part of the HMO network.
Even though the restrictions are many, but an HMO just might be the most suitable because of its low cost. The premiums for HMO are usually far cheaper than other plans. If you and your family tend to lead a healthy life and only need a checkup once or twice a year, an HMO might be the perfect plan for you.
Conversely, due to the fact that HMO's are very reasonably priced, it is necessary for the doctors to see a number of patients’ everyday so as to make enough money. There have been complaints of the doctor not giving patients enough time at an HMO. On the other, the money that is saved is so appealing at times that healthy people usually have no issues going to an HMO.
What is a PPO?
A Preferred Provider Organization, or PPO, is comparable to an HMO in that it is a group of doctors, hospitals and health clinics that have an agreement with insurance companies. On the other hand, these organizations are much more freely organized, and not almost as limiting as HMOs.
With a PPO, you can see the doctor of your choice, even though the fact remains that doctors that are outside the network of the PPO will charge far more. Like an HMO, your doctor can become a member of the PPO network, but it may take some time before that agreement is in effect for you to see cost savings. Unlike an HMO, it is not necessary for you to get the approval of a doctor to see a specialist, but again, if that specialist is not part of the PPO group to which you are registered, you might have to pay extra.
Even though PPO’s cost more than HMO’s, a number of people prefer them due to the fact that they believe that they have more control over their health care decisions. Another factor which affects this decision is that physicians give more time in a PPO plan than in an HMO.
What if My Doctor Is Not a Part of Any Plan?
A number of people who have found their family doctors would not want to switch to other doctors. If your doctor is not a member of any plan, you could always ask them to register as a provider to your insurance plan. A number of doctor’s offices might be glad to become a member as it would give them a chance to see more patients. Even if they do not join in, there is no harm in asking!
If you have to decide whether you want an HMO plan or PPO, you would have to decide whether you want to keep your doctor or not. After this decision you would have to pay higher rates if you want to keep your doctor till the time that he/she becomes a part of your insurance plan.
Make sure that you go through your options carefully before making any decision for yourself and your family.
| 
