HMO or PPO – Which Of These Group Health Plan Options Is Best

While there are lots of different options available for health insurance, making sure you’re getting the plan in place you need, can be confusing. Policies from Colorado health insurance companies for individuals and families are readily available but without being a part of a group plan, they can be expensive. Since there are different types of group policies available, you’ll want to make sure you’re getting into a group that suits your needs.

There are two main types of Colorado health insurance group policies: HMO or Health Maintenance Organizations and PPO or Preferred Provider Organizations. While both types of policies have some similarities such as having to pay monthly premiums and that the insurance company will pay a certain percentage of medical bills, that’s where most of the similarities end.

An HMO is designed to be a “single point” approach to health care. You’ll select a primary care physician (PCP) in the network of doctors in the organization as well as primary care physicians for the other members of your family. These PCP’s will manage your entire health care platform including making referrals to specialists and other doctors as needed. You’ll have to have a referral from your PCP in order for the insurance to be applied correctly. If you have to see a physician outside of the network, you’ll probably be responsible for all or most of the bill.

PPO’s are based on contracts with a network of preferred providers to give you more flexibility in choosing which doctors and other medical professionals you can see. Since you’re not being limited by going through your PCP to get a referral, you can see whoever you want that’s in the network and your Colorado health insurance will pay for it as long as you’ve met the yearly deductible and take care of any co-pays that may be necessary.

HMO in-network doctors are paid when they file Colorado health insurance claims which mean you don’t have to worry about any additional paperwork. The drawback is that if you have to use a doctor or facility that isn’t a part of their network, you usually wind up having to pay for any bills yourself as the HMO won’t cover any part of it. Also, you’ll still have co-pays for doctor visits and medicines

PPO’s handle out of network claims a bit differently as you may have to cover the full bill and file a claim to be reimbursed for it. You’ll also be responsible for meeting your yearly deductible as well as co-pays on doctor’s visits and medicines on in-network claims as well. After you meet your yearly deductible, the insurance will kick in and pay the larger percentage of your medical bills. By sitting down with a Colorado health insurance agent you’ll be able to figure out which group policy will fit your needs best and ultimately what your costs will be.

Doing your research is key when choosing which employer group health insurance option is best for you and your family. Royce Vangoff changed his Colorado health insurance when he found a plan that worked better for him.

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