Factors To Consider When Deciding Between HMO And PPO Health Care Plans

Faced with ever-increasing medical costs, selecting the best health plan for you and your family requires informed decision-making on your part. There are two basic forms of employer sponsored health care plans: HMO & PPO. Both of them have distinct advantages and disadvantages that you must be aware of in order to be able to make the best decision possible.

Families without a health plan receive far less preventative health care and very often, they are not diagnosed with a disease until it reaches later, less treatable stages. Compounding the problem, individuals without a health insurance plan, even after diagnosis, receive less treatment. Studies have shown that approximately 18,000 people die each year from inadequate medical care. Studies also show that individuals without a health care plan are hospitalized 30-50% more often for avoidable conditions. With an average emergency room visit costing $3,300, the investment in a health insurance is clearly worthwhile.

Managed Health Care Benefits

Managed health care plans reduce medical costs to enrollees, allowing them to receive medical care that they might not otherwise be able to afford without a medical plan. Health insurance companies develop contracts with health care providers, promising to provide specific doctors and hospitals with more business through their health insurance. In return, doctors and hospitals agree to provide those services at a lower cost.

HMOs and PPOs are both managed health care plans that reduce the cost of medical treatment by combining contributions of enrollees and gaining the benefits of scale. There are other medical plan mechanisms put into place to reduce medical costs by encouraging such incentives as preventative care, enforcing limitations to coverage and increased beneficiary cost sharing. Each health care plan has advantages and disadvantages that must be considered. There are significant price, service, and flexibility differences between these two types of medical plans. Whichever medical plan you select, you will be able to receive more medical care for far less money than if you had no insurance at all.

HMOs Are An Inexpensive Option

HMOs, or Health Maintenance Organizations, are health plans characterized as cooperatives of doctors, hospitals, and other medical providers. HMOs such as Kaiser Permanente and Aetna are your least expensive and most restrictive health care plan. Under HMO policies, health insurance providers have agreed to provide their services at fixed prices and copayments are generally very low. Since health care providers receive less money for their services, they tend to see as many patients as possible.

There are many rules covering HMO medical plan services, the most important one being the requirement that your physician be a member of the HMO. If you need to see a specialist, you must see your primary physician for a referral. HMOs focus primarily upon preventative health care services such as immunizations and physicals. HMO doctors are paid on a per office visit basis.

PPOs Cost More And Provide More

PPOs, or Preferred Provider Organizations, are health care plans that have contracts with insurance companies to reduce medical expenses to enrollees. PPOs like Blue Cross Blue Shield are more expensive than HMOs, but you have much more freedom about who you see. Referrals are not needed to see a specialist, but your medical plan will require that you pay more to see a doctor that is not a member of the PPO medical plan.

Enrolling in a PPO provides you with more control over your health care plan as well as greater autonomy. Unlike HMOs, emergency room visits are generally covered under PPO medical plans. PPO doctors are paid on a retainer basis, thereby providing them with no incentive to unnecessarily prolong treatment.

One aspect of a managed health care plan is that treatments are reviewed by the insurer. In some cases, this can eliminate unnecessary procedures and overcharging, thereby saving both the insurer and enrollees' time and money. Whichever coverage you select, you will provide your family with access to the benefits of regular, preventative care and early diagnosis of more serious conditions, increasing the likelihood of recovery. Eat right, stay fit, and enroll in a health care plan!