One of the significant benefits of securing a full-time position is that you’re finally eligible for, well, benefits. The ones that most people are most concerned bout are health, vision, and dental (but many employers offer others, like life insurance, disability insurance, pet insurance, and more). One of the significant decisions most people will have to make once they’re offered health insurance is choosing between an HMO and a PPO. Let’s investigate the differences between the two to help you make that choice.
What Even Are They?
An HMO is a health insurance provider that has set up a network of doctors, hospitals, and specialists that they consider their network, and they only cover care when you are within their network. These providers have joined the network and agreed to work for the fees that the HMO sets up and maintain the standards of care that the HMO demands. A PPO offers more flexibility. While there is still a network of doctors, hospitals, and specialists, you have the freedom to go outside of the network for a higher cost, and the treatment will still be partially covered.
Both types of plans have networks because that is the system that allows both to set the costs of the services they cover. The major difference is that in an HMO you are limited to your network – if you go outside it almost nothing (and usually, literally nothing) will be covered by the insurance plan. For a PPO, the network itself tends to be broader and cover more but there is also the choice to go out of network and still have a portion covered (though it is always a much smaller portion).
Primary Care Physicians
In an HMP, you almost always have to see your PCP, Primary Care Physician, before you go to any specialist, and that PCP will determine what you need and who you should see. In a PPO, your PCP is there to treat you generally, but you don’t need their referral to seek treatment from a specialist.
Since you get more freedom and flexibility from a PPO, generally you also pay more for it. In almost all cases, the PPO option will be the more expensive health insurance plan over the HMO.
As stated, for an HMO, out-of-network care is not usually covered (except in an emergency), while for a PPO it is covered at a much lower rate.
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Malden Solutions has a wealth of expertise in providing employer insurance solutions, HR solutions, and individual insurance solutions to businesses both big and small. Our team of seasoned professionals can help you navigate the rapidly-changing world of insurance with ease. We partner with businesses and individuals throughout the country to provide our dedicated services for employee benefits but also work within our surrounding communities in Maryland, Northern Virginia, and Washington, D.C. Contact us today to learn more about how we can provide effective, dynamic solutions for your business. Stay connected with us on Twitter, Facebook, and Linkedin.