PPO Plans Vs. HMO Plans

It's good to have choices.  When it comes to health insurance, you have your choice of several plan types.

The two that are available to you on Kynect are a Health Maintenance Orgaization(HMO) and a Preffered Provider Organization(PPO).

Underterstanding PPO PLans

PPO Plans provide more flexibility when choosing a doctor or a hospital.  They also have a network of doctors in which you will pay less to visit, but the plan has fewer restrictions.  Meaning you may go out of the network to see a particular specialist or doctor, however the price may be a little more than a network provider.

Key features of a PPO:

• You can see a doctor or go to a hospital outside the network and you may be covered. However, your benefits may be better if you stay in the network.
  
• You can see the doctor or specialist you'd like without having a referral from your primary care physician
  
• much less restrictive plan, and you still receive network prices if you remain in the network, reducing your out of pocket expenses.
  

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Understanding HMO's

An HMO plan gives you access to certain doctors and hospitals within it's own network.  A network is made up of providers that have agreed to lower their rate for plan members and also meet quality standards.  But unlike other insurance plan types, care is covered ONLY if you see a provider with that HMO's network. There are few opportunities to see a non-network provider. There are also typically more restrictions for coverage than other plans, such as allowing only a certain number of visits, test, treatments, etc...

Key features of a HMO:

• you're required to select a primary care physician(PCP), who will determine what treatment you need
  
• you will need a PCP referral to be covered when you see a specialist or have a special test done
  
• If you opt to see a doctor outside the network, there is NO coverage, meaning you have to pay the entire cost of medical services
  
• If you need surgery you must use an IN-Network facility.
  
• premiums are generally a little lower for HMO plans
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