PPO or “Preferred Provider Organization” plans are the most popular with Individuals and Families. As the name implies, with aPPO you’ll get your medical care from doctors or hospitals on the insurance company’s list of preferred providers. It’s up to you to make sure that the health care providers you visit participate in the PPO you select. It’s important to note that services rendered by out-of-network providers may not be covered at all or are paid at a lower level.
Here’s how it works: Healthcare providers are contracted with specific health insurance companies to offer plan members a discounted rate. Typically, you will be able to see doctors and specialists within the network
at your own discretion. It’s likely there will be an annual deductible you must pay before the insurance company starts covering your medical bills. Certain services may also require a co-payment or you may be required to pay a certain percentage of the bill. It will all depend on the specific plan you select.
HMO means “Health Maintenance Organization.” HMO plans offer a wide range of health care services through a network of providers that arec ontracted, or who agree to provide services to members. Though there are many variations, HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospital. As a member of an HMO, you’ll be required to choose a primary care physician (PCP), for most of your healthcare needs. Before you can see a specialist, you’ll need to obtain a referral from your PCP.
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A POS (Point of Service) plan is a hybrid of HMO and PPO plans. As with an HMO, members of a POS plan may be required to choose a primary care physician from the plan’s providers. Physician visits may/may not be subject to a deductible. Like HMOs, POS plans typically offer coverage for preventive care visits.
No matter which metal category you choose, you can save a lot of money on your monthly premium based on your income.
When you fill out a Marketplace insurance application, you’ll find out if you qualify for these savings. Learn how you can save on your monthly insurance bill with a premium tax credit.
PPO or “Preferred Provider Organization” plans are the most popular with Individuals and Families.
If you already have an insurance plan and want to keep it, review your benefits to see which services are covered.