What is PPO medical health insurance?
Reader question:
What is PPO medical health insurance?
Jose
Great question.
PPO medical health insurance, also known as preferred provider organization, is one of the strictest forms of medical health insurance plans out there. The other options are the traditional indemnity health insurance plan, which is most flexible; the HMO health insurance plan, which is stricter but not very much; and the POS medical health insurance plan, which is a mixture of the two that ends up being somewhere in between. Standing by itself on a different part of the stage is the PPO medical health insurance plan, which has similarities to the other three, but is all its own.
The very good thing about PPO medical health insurance is that it is cheap. That is the thing that keeps the people it insures within its plan. The cheap premiums and decent co-payments convince people to stay within the network and continue receiving their health care insurance through the PPO medical health insurance plan.
The Good:
- The co-payments are very, very cheap. And I mean very. If you just go for a regular check up, you’re probably going to end up paying your doctor a co-payment of no more than ten little dollars.
- You don’t have to get a referral to go see a specialist. That isn’t an open ended invitation, though. In order to be covered by the policy when go to said specialist, he has to be a part of the PPO network.
The Bad:
- You can go outside of the network to see a different physician, but the coverage doesn’t extend quite as much, and you’ll have to pay for the visit at the time and then send in a health insurance claim to be reimbursed once you get the bill.
- If you do go outside the network, that’s where the deductible comes in. You’ll probably have to pay one, and it’s also true that if the physician that you visit costs more than the ones within the network, you won’t be reimbursed for the difference.
Cheers,
Fashun Guadarrama.
Kinds of group health insurance
Reader question:
What kinds of group health insurance are there?
Richard
Great question.
There are four kinds of group health insurance, although the most popular ones these days are the HMO and the PPO. There have been a lot of changes in employment based medical insurance in recent years, and the employee has come out the winner, with more and more benefits as well as lower premiums and better options than ever before.
- Traditional group health insurance.
In 1988, the majority (74%) of group health insurance was provided in the traditional way. Well, things have changed quite a bit, and as of 2003 that number has dropped to only 5%. The best thing about traditional group health insurance is that it has room to move around in. You can pick any doctor you want, go to any hospital you want, and see a specialist without having to get a referral, among more things. The main reason that you don’t see traditional group health insurance around anymore is because this amount of freedom meant high costs, both for company and employee.
- HMO group health insurance.
HMO means Health Maintenance Organization. This was the first group health insurance type to offer an option other than the traditional kind. This is the cheapest group health insurance option, but only because it has so many limits. A network of doctors and hospitals is created so that you can choose from among that list, and can only go anywhere outside of it and still be covered is if you get a referral from a doctor on the list. If you go to a doctor or hospital not in the network, you’ll be paying out of pocket.
- PPO group health insurance.
PPO means Preferred Provider Organization. This is the most oft-used type of group health insurance these days. It’s similar to both traditional and HMO group health insurance, because you can go within a network or outside. If you go within the network, then you’ll get very low prices and most often won’t have to co-pay anything. If you go outside, you’re still covered, it will only cost more, but still less than if you had no coverage.
- POS group health insurance.
POS means Point of Service, and is also called an open-ended HMO. This is very similar to PPO because there is a network of doctors which the insured must visit and get referrals before going outside the network if they want to be fully covered. They can still go outside the network without referrals, but it will cost them more, though they will still be covered.
Cheers,
Fashun Guadarrama.
Cheap health insurance Indiana–HMO or PPO?
Cheap health insurance in Indiana can be easy to find, but be careful not to be misled in to purchasing bad insurance. Personally, I would never get involved with an HMO. They are cheaper than most PPO policies, but the coverage is poor and the service even worse.
If you or anyone you know has ever tried to see a specialist while on an HMO, you know how frustrating it can be. A few years ago, my cousin’s coverage changed toward the end of her pregnancy, and she actually had to go by the doctor’s office during labor to get a referral to be able to check into the hospital. At least she knew the ropes and didn’t get caught with thousands of dollars in medical bills that would have been unpaid if she hadn’t gone in for that painful referral first.
HMOs are also notoriously known for keeping patients from needed care through the referral stipulations. A friend’s son suffered irreversible hearing loss because they couldn’t get their assigned pediatrician to refer him to an ENT early enough. When they finally did see an ENT two years later, he told them that if he had seen the child sooner, the boy wouldn’t have such severe hearing loss.
PPOs have problems too, and they are also large corporations focusing on making a profit, but at least you can get an appointment with anyone on their extensive provider list whenever you need to.