HMO vs. PPO vs. Fee-For-Service health care plans

HMO vs. PPO vs. Fee-For-Service health care plans

Deciding which type of health care plan is best for you and your family can be a complicated endeavor. Due to the Affordable Care Act, you are required to carry health insurance, but you will need to understand the health care plan categories available to you before knowing which fits your situation. There are some standard differences to take into consideration.

Health Maintenance Organization (HMO) policies generally carry lower premiums, but they are more restrictive with regard to which providers and hospitals you can visit. Most HMO’s also require that you get a referral from your primary care physician prior to being able to visit a specialist.

Preferred provider organization (PPO) policies generally have higher premium rates than HMO’s, and though they do have a network of preferred providers, allow you to visit doctors and facilities outside the network. An additional benefit of PPO’s is that you’re entitled to make an appointment with a specialist without having to first go through your primary care physician.

Fee-For-Service plans are less common than HMO’s and PPO’s, and they are generally the most expensive. With this type of health care plan, you pay for your doctor’s visits, tests, and hospital visits out of pocket, and then apply to the insurance company to be reimbursed.

Which one is right for you?

All health insurance plans include premiums, deductibles and copayments, and they vary from one to the next. While one plan may cover regularly scheduled appointments, another may require that you meet a yearly deductible first. In order to estimate what these costs will be, you’ll need to look at the whole picture. Health factors, such as existing problems or family history of disease will influence the total yearly price you pay for healthcare.

Other factors, such as age and gender, also have an affect on which health care plan is the best deal for you. For example, a female between the ages of 20 and 40 may want to consider the amount each health care option will cover in the event of pregnancy and childbirth.

No more guessing

There are many factors to consider when deciding between a HMO vs. PPO vs. Fee-For-Service plan. Sound like a lot of time and research? Fortunately, there is another option. Enlisting the help of an independent health insurance agent can take all the worry out of this process. Independant agents won’t guide you toward a particular plan or insurer. Instead, they make professional recommendations based on your specific situation and future needs.

Dan Fraisse has been helping clients find the health care plan that best suits their needs for over three decades. He has a wealth of knowledge on the industry and the individual insurance providers.

Take the worry out of choosing health insurance. Put Dan on the case.