Health Insurance Buyer?s Guide

Health Insurance Plans

Health Maintenance Organization (HMO) Plans

Generally, HMOs have low or even no deductible and the co-payments will be relatively comparatively low as well.  You pay a monthly premium that gives you access to coverage for doctor appointments, hospital stays, emergency care, tests, x-rays and therapy.  You will have to choose a primary care physician (PCP) within your insurance provider’s network of physicians, and in order to see a specialist you need to receive a referral from your PCP.  Under an HMO plan, only visits to doctors and hospitals with the insurance company’s network of providers are covered; you’ll have to pay for visits if you go to an out-of-network doctors or hospitals your insurance will not cover the costs.

Preferred Provider Organization (PPO) Plans

Under a PPO plan, you will use the insurance company’s network of doctors and hospitals for any services or supplies you need.  These healthcare providers have been contracted by the insurance company to provide services at a discounted rate.  Generally, you will be able to choose doctors and specialists within this network without having to choose a primary care physician or get a referral.

Before the insurance company will start paying for your medical bills you will usually need to pay an annual deductible.  Also, you may have a co-payment for some services or be