Do you know the number one reason for personal bankruptcy in the United States?  It is medical expenses.  In the US, medical expenses are so high that you often cannot afford hospital bills without health insurance.  Even if you have health insurance, many health plans offer a different level of benefits such as deductibles, coinsurance and out-of-pocket expenses.  For this reason, shop smart with a health insurance broker who can help you to choose the right health insurance plan based on your health and financial situations.

Health insurance plans vary from insurance company to insurance company. But they are generally divided into three categories: HMO, PPO, and EPO.  While these plans can provide the coverage that you need, it is important to understand the differences.  Failing to identify the differences between HMO, PPO and EPO plans could lead to unexpected costs and disappointment in having to switch your providers due to a change in insurance coverage. These plans provide medical coverage, but there are substantial differences in how they work and how much they cost.

HMO (Health Maintenance Organization)  

HMO plans are the most common and affordable health insurance. They provide coverage for in-network  hospitals and doctors. The hallmark of an HMO plan is that you need to select a primary care physician (PCP). Your PCP is the doctor you go to see for annual check-ups or when you are sick.  You can choose a PCP but they must fall within the HMO’s local network.  Your PCP can be an internal medicine and a family doctor, and a pediatrician for children, and an obstetrician and gynecologist for women. When you need to see a specialist such as gastroenterology, cardiology, ophthalmology, or dermatology, you will need a referral from your PCP within the local network of healthcare providers. Everyone is determined and coordinated through your PCP.

Insurance premiums are relatively cheaper than PPO plans, and the out-of-pocket costs are lower in case of hospitalization, outpatient examinations, and surgery.  Because of this, HMO plans are good for people who are healthy or who do not go to the hospital often.  In case of an emergency, you can go to the nearest hospital for treatment.

PPO (Preferred Provider Organization)

With PPO plans, you do not need a referral from your PCP if you need to see a specialist.  Also, you are not required to have a PCP either. Basically, you have the freedom to choose your providers without going to see your PCP first.  You can receive treatment at the predetermined price between your doctor and insurance company.  Therefore, you only have to pay a pre-arranged amount for treatment or hospitalization. However, you should use a doctor or hospital (in network) contracted with your insurance company, otherwise you might have to pay more.  So before choosing insurance, you should check the insurance company’s network.

Generally, PPO plans have higher premiums, deductibles, and out-of-pocket maximums, compared to HMO plans. There is no need for you wait for a referral, and you can get the care you want quickly.

EPO (Exclusive Provider Organization)

An EPO plan is a hybrid of the HMO and PPO plans.  These plans are increasingly popular in the recent years.  Similar to HMO plans, there is no insurance benefit for doctors and hospitals outside the network. Similar to PPO plans, you can go see any doctors and hospitals freely as long as they are within the network. You do not need to choose a PCP, and you do not need prior approval before seeing a specialist. However, there are no benefits associated with out-of-network doctors or hospitals.  So, before selecting an EPO plan, you need to double-check the insurance company’s local network.

Premiums are relatively cheaper than PPOs and EPO plans have fewer doctor visit restrictions than HMO plans. And in case of an emergency, you can go to the nearest hospital regardless of the network.

Work with a Health Insurance Broker

Now that you better understand the differences between HMO, PPO and PPO plans, you are ready to get an insurance quote.  Whether you are currently uninsured and in need of coverage or want to reassess your current health insurance plan, Skyline Benefit is here for you. Skyline Benefit is an independent health insurance broker with a variety of HMO, PPO and EPO plans and price points.

Call today for a free consultation (714) 888-5116