Whether you get Kentuckyindividual health insurance through your employer or purchase a plan onyour own, you would have to consider various points before you choose betweenan HMO and a PPO
Most Kentuckians are enrolledin a managed care plan. Whether you get Kentuckyindividual health insurance through your employer or purchase a plan on yourown, you would have to consider various points before you choose between an HMOand a PPO.
Under managed care, theinsurance company contracts with physicians, hospitals, and other healthcareproviders that collectively form the plans network. There are basically twotypes of managed care plans health maintenance organizations (HMOs) andpreferred provider organizations (PPOs). Where you live or, for some plans,where you work, determine your eligibility to enroll in an HMO. There are alsopoint-of-service (POS) plans that combine features of both HMOs and PPOs.
HMOs vs. PPOs
To choose a HMO plan and a PPOplan, you have to compare them. For this, it is necessary to understand the basicdifferences between these two types of plans.
Choiceof healthcare providers: Managed care plans require you get most orall healthcare services from providers affiliated with the Kentucky healthinsurance plan. With a PPO, you canchoose from preferred providers within the plans network or fromout-of-network providers. If the provider is not in the network, you would haveto pay more.
Primarycare physician (PCP): With Kentucky individual healthinsurance through an HMO, you would have to choose a PCP to coordinate yourhealthcare. If you need to see a specialist in the network, your PCP would haveto provide you with a referral. You would most likely have to pay for yourhealthcare if you do not have a referral or consult a doctor that is not inyour HMOs network. With a PPO, you do not have to select a personal carephysician. You can choose to see any doctor, though you would have to pay moreif this doctor is not in the preferred network.
Specialistconsults: Except in an emergency, an HMO requires you to have a referral from your PCP to see aspecialist such as a surgeon or a cardiologist. No referral is needed toconsult a specialist with a PPO, unless the specialist requires one.
Insuranceclaims: If you choose a Kentucky individualhealth insurance plan that is a HMO, you will have little paperwork. This meansthat your provider, and not you, would have to file the claim. You may not becharged or sent a bill by your provider. With a PPO plan, you may have to makethe full payment to a provider for out-of-network services, and then file aclaim to get reimbursed. Also, the PPO may pay only part of the bill youwould have to pay the rest.
Costs: With aHMO, your out-of-pocket costs are generally limited to the low amount specifiedin the plans brochure. The charges would comprise that for in-network servicessuch as copayments for doctor’s visits, procedures and prescriptions. In a PPOnetwork, you would be responsible for the copay and for the annual deductible.
Choose the Right Kentucky Health Insurance Plan
Comparing your options to make the right decision onbuying a health insurance plan is easy with professional guidance. Contact anexperienced licensed Kentucky health insurance agent to enjoy benefitssuch as free quotes from leading health insurance companies and expert adviceto choose a plan.