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Choosing
between an HMO a PPO can be a difficult decision to make. On one
hand, an HMO seems cheaper than a PPO. But on the other hand, you
may have to switch doctors to receive coverage from an HMO.
PPO’s allow
you to choose from doctors who belong to the PPO network. You can
also visit non-network physicians for an additional fee. In most
cases, you can seek care when needed without having permission from
the plan first. Keep in mind that with a PPO it usually costs
you less in out-of-pocket money if you visit “preferred providers.” You
typically pay a deductible coinsurance, which is a fixed percentage
of the covered charged. You are responsible for any charges not
covered by the plan.
HMO’s
require a
set co-payment, a set dollar amount usually around $10-$15, each
time you visit an HMO primary care physician. In most cases, you
will not be required to pay a deductible. With an HMO, you select
a primary care physician to manage all of your health care needs
including referrals to any needed specialists. There is no coverage
for visits to a doctor not in the HMO which means you are required
to pay the full medical bill (expect for emergencies).
Before
you consider switching doctors to one who belongs to the HMO network,
check to see where the doctors are located and if they are taking
new patients. With the money you save through your health plan you
may up spending it in time and travel expenses. If you
join an HMO or POS, your primary care physician must approve all
specialty care in advance. Most of the time, this approval is easy
to get and you'll have some choices among the network specialists.
It's important to consider though that some doctors will only refer
patients to specialists in their own group. If choosing your own
specialist is importanct to you and you want to join an HMO, call
the plan to ask about ability to choose a specialt.
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