The question really is, which type is better for you? If you’re able to choose between a health maintenance organization (HMO) and a preferred provider organization (PPO), you’ll need to evaluate the coverage that each offers and determine which one best suits your needs. Although both HMOs and PPOs are types of managed care systems, each manages health care differently.
HMO members have to pick a primary care physician (PCP), who provides general medical care and referrals to specialists. Both the PCP and any specialists you see must belong to the HMO network. The PCP must approve your request to see a specialist. PPO members aren’t required to choose a PCP and can see a specialist without a referral.
Out-of-network care (except for emergency care in some situations) is generally not covered by an HMO. A PPO won’t require you to receive care within the network, but you’ll save money if you do. For instance, the PPO may reimburse 90 percent of your health-care bill if you saw a doctor within the network, but only 70 percent of your bill if you saw a doctor outside the network.
HMO members usually pay a small co-payment for care (e.g., $10), but aren’t required to meet an annual deductible. If you belong to a PPO, you may have to meet a deductible (especially for hospitalization) and pay a larger co-payment (e.g., $20) than an HMO member when you receive care.
So what it boils down to is flexibility versus cost. If you routinely need to see specialists, travel a lot, or are willing to pay more to see whatever health-care provider you choose, then a PPO might be the right choice. But if saving money on health care is your main concern and you’re not worried about access to specialists of your choice, consider joining an HMO.
If you have questions, contact the Experts at Henssler Financial: experts@henssler.com or 770-429-9166.
Disclosures
The following information is reprinted with permission from Forefield, a division of Broadridge Financial Solutions, Inc. This article is meant to provide valuable background information on particular investments, NOT a recommendation to buy. The investments referenced within this article may currently be traded by Henssler Financial. All material presented is compiled from sources believed to be reliable and current, but accuracy cannot be guaranteed. The contents are intended for general information purposes only. Information provided should not be the sole basis in making any decisions and is not intended to replace the advice of a qualified professional, such as a tax consultant, insurance adviser or attorney. Although this material is designed to provide accurate and authoritative information with respect to the subject matter, it may not apply in all situations. Readers are urged to consult with their adviser concerning specific situations and questions. This is not to be construed as an offer to buy or sell any financial instruments. It is not our intention to state, indicate or imply in any manner that current or past results are indicative of future profitability or expectations. As with all investments, there are associated inherent risks. Please obtain and review all financial material carefully before investing. Henssler is not licensed to offer or sell insurance products, and this overview is not to be construed as an offer to purchase any insurance products.
