Divorce and Health Insurance Planning: HMOs and PPOs

Choosing a new health insurance plan can be amazingly confusing without a checklist to keep you focused on the plan features that are most important to you. Part one of this blog addressed the importance of reviewing a plan’s provider list of “in network” doctors, hospital, and other medical providers, and the trade-offs involved in choosing a plan based on its low monthly premium payment.

The next consideration on the checklist is the type of health insurance plan that will best serve your needs. Bewildered by the lingo? HMO? PPO? POS? HMO’s usually offer the least expensive monthly premiums, but come with the most restrictive benefits. You have to use only the plan’s list of doctors, hospitals, and other providers. If you go off of their provider list, you won’t be covered. You also have to choose a primary care physician who will act as a gatekeeper of sorts, deciding when and if your health requires referral to a specialist. If you want more freedom in your medical care choices and can pay more to have it, an HMO would not be a good choice for you.

A PPO plan also has a list of “in network” providers, but these plans are less restrictive than HMO’s. You will not be required to choose a primary care physician and can see specialists without anyone’s permission. If you stay on your PPO plan’s in network provider list, most of your medical expenses will be covered after you meet your deductible. Many PPO plans will pay for your visits to doctors without requiring you to meet your deductible amount first. Most plans, however, charge you a copay for these doctor visits. If you have frequent visits to your doctors, be sure your plan charges a copay that you can afford. A PPO will also pay some percentage of your medical expenses if you choose to go to an out of network doctor, hospital or other provider.

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