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Kentucky Health Insurance – Choosing Between HMOs and PPOs

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 plan’s 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 plan’s 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 HMO’s 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 plan’s 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.

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