More Information on HMO and PPO Health Insurance Plans
Part 2, Chapter 7: Managed-Care Plans Page 7
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However, the available information is not yet complete. Thus, at this point, you'll also have to rely on your own research to evaluate the degree to which a particular HMO may meet your needs. Before joining an HMO, it may be helpful to compare various programs and to discuss plan rules with program representatives. It may also be helpful to try to speak with HMO participants who have health conditions similar to your own to determine their level of satisfaction with the medical care they have received.
It's important, as well, to make certain that there are net work providers available in your geographic area -- including the types of specialists that you are likely to require -- before joining an HMO, and to make certain that the doctor you're considering choosing as your primary care physician has openings for new patients. In addition, it's important to be certain that the hospitals that are part of the HMO network are conveniently located.
Preferred Provider Organizations
PPOs (Preferred Provider Organizations) have established provider networks. Consumers must generally make use of the providers in the network in order to allow for maximum reimbursement. However, Preferred Provider Organization rules also permit consumers to see doctors outside the plan network. In such cases, though, a consumer's out-of-pocket costs are likely to be higher than they would be if the consumer consulted a provider who was part of the plan network.
A Preferred Provider Organization may thus provide some of the advantages of a managed care plan when the consumer makes use of network physicians, but it may also offer some of the advantages of a traditional plan by allowing for some cost savings when services are provided by physicians outside the plan network.
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