HMO vs. PPO – What You Need to Know

So uh life insurance health insurance here and for my own family alright now I'll show you some more tidbits what I'm looking for it's a it's a mess no other way around that but just because it's a mess doesn't mean you should be ignorant and just pretend it doesn't exist so let's start today with a difference between an.

HMO and a PPO I think that's a starting point for sure and the reason I want to start with that is because of my and my wife's experience with both of these in terms of ourselves and some of the people we know as well and then I'll do other videos on this because this is a process I'm going through now I'm 48 years old have four kids I left my job.

In March of 2017 so just got off Cobra two months ago all right now I have open enrollment for Obamacare and we're looking at stuff I know my wife she works part-time just decorating Christmas tree your Christmas decorations that you hang on your Christmas tree if I 10 bucks an hour I'm doing the YouTube and meeting clients on.

Occasion so you know we got a little bit of money coming in but certainly not what we're making before and and Cobra is a big deal and that was a cheap if that I'll share with you here next video and how you can find out what your Cobra would be so now we're on our own and right now we do have meta share I'm not going to dive in that here today but the.

Question is can we qualify for Obamacare credits that's all we're looking at so what happens in 2019 right now we're covered under Medicare I'm going to do a podcast with a lady a doctor in Texas who's a direct direct primary care DPC which is primary care providers that you pay a monthly fee that doesn't go through insurance which.

I'm a huge fan of that but again was the stuff for a cast traffic I don't know so we're gonna dive into that too so lots of different discussions that I'll share with you as we go forward here so don't forget to subscribe so the first thing got to understand I just did HMO versus PPO and Medical Mutual from Ohio so I did I try to get a you know coat myself.

A plant just to see if they'd let me a 3004 which is my zip code they would not because they're only in high so a couple things on health insurance or insurance actually if you see the word mutual that's really what you want to go that's kind of the equivalent of a credit union for insurance company alright so that's owned by his.

Policyholders Vanguard would be the equivalent of a mutual company for investments as owned by a shareholders not the shareholders like you know stock market shareholders but as investors is actually the right word a USAA is not quite a mutual company but it is owned by the members alright so you want to start with mutual because it is owned by.

Its in this case its insured or the members or like a credit and the members and investors like a place like Bank are so what's this actually and I did a couple I looked at a bunch of different things on this and this is the best one I found what's the difference between HMO and PPO s HMO is health maintenance organization.

PPO is preferred provider organization all right so it's good AB choices when it comes let me see if I can't make this bigger on second here I guess that's things I can get all right good there we go it's good AB choices when it comes to health insurance you have your choice of several plan types typically you've.

Heard of an HMO and a PPO preferred provider organization generally speaking the difference between HMO plans includes the size of the plan the plan network the size of the plan Network and that's the critical thing ability to see specialist plan costs and coverage for out-of-network services an HMO gives you access to a certain doctors and.

Hospitals within its network a network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards but unlike a PPO care under an HMO is covered only if you see a provider within that network there are few opportunities to see a non-network provider.

There are also typically more restrictions for covers and other plans such allowing a certain vision visits tests or treatments some plans may require you to select a primary care physician who will determine what treatment you need some plans you may need to see a PCP referral to be covered when you see a specialist or have a.

Special test done if you have to see a doctor outside of an HMO Network is no coverage meaning you're gonna pay the whole doggone thing premiums are generally lower for HMO plans there's usually no deductible or a smaller one some HMO plans including those offered by Medical Mutual which is this company do not require you to see a PCP or have.

A referral to see a specialist and that's a pretty big deal but I don't know about Medical Mutual you'd have to look at that if your resident Ohio might not be a bad idea to do that PPO plans provide more flexibility when picking a doctor or hospital they usually feature a network of providers but there are there are fewer restrictions on seeing.

Not net non network providers in addition your PP O insurance will pay you will pay if you see a non-network provider so if you go to a non network you're still going to be insured unlike the HMO but it's all on you although they're gonna charge a little rate now they're gonna pay a lower rate so if you go if you're a PPO and you go see a.

Non-network provider you still have insurance coverage but it won't be the same extent as it would be with in-network if that makes sense but you still have coverage so it won't be all on you I here are some key features you can see a doctor or specialist you'd like without having to see a primary care.

Physician first I'm telling that's a big deal these primary care physicians are booked I'm just as you know sometimes the hard to go see somebody to get a referral to go see a specialist which is what an HMO typically requires so I mean let's just say your primary care physician is booked four weeks out and you know you're dying today you know.

You're bleeding you in a tourniquet you can't keep a tourniquet on more than 24 hours you gotta get that tourniquet off but you guys see a specialist but you can't just go to the doctor on the door the specialist you gotta go to your primary care physician the primary care physician says sorry Charlie I'm put for four weeks straight come back in a month.

By then I'm gonna bleed out being facetious but you know I'm talking about you can see a doctor go to a hospital outside your network and maybe covered your network your benefits will will be better if you stay within the network of course and premiums tend to be higher and it's common for there to be deductible so HN Oh HMOs tend to be more.

Affordable less premiums and you usually get less coverage and more restrictions PPOs are more flexible and provide greater coverage but come with a higher price tags and most likely a deductible you can see the summary of the different options access to a network of network yes so remember the network if you list my podcast my videos with Jo we talked.

About medic not Medigap Medicare Advantage remember those insurance companies are putting two get together a network of providers Doc's essentially and as far as rural locations and you used Alaska there Jevon not enough that's just of a network in which an insurance company can you to go and put those networks together in a proper.

Profit so just can't and so because that there's no Medicare Advantage policies and in Alaska Saul Medigap and the same thing is here I mean if you if the network is going to be small because the insurance company says look I can't I can't organize it very well and profitably they're just not going to do it or it'll be a very very small network.

To begin with which is typical of an HMO HMO networks are quite small generally speaking and ability to see a doctor you want without PCP primary care physician as a PPO referral from a PCP not needed to see a specialist again that's a PPO low to no doctor and lower premiums that's the HMO and coverage for medical expenses outside of the network and a.

PPO that could be possible deciding between a HMO and a PPO if you have a choice between those two types of plans consider your needs availability of HMOs in your area and your income if you're looking at an HMO take a close look at the network to determine if the choices of doctors and medical facilities are enough to meet your needs a PPO gives.

You more freedom but a cost more so this is a pretty good open up put a link to notes but that's the difference between HMO and a PPO so an HMO is based on the network you're gonna have a limited amount of doctors in that network if you don't typically need to go see a doc alright or you just don't or you just for whatever reason then that might.

Not be a big deal because the premiums going to be significantly lower than a PPO and on top of that you just don't go there how much anyway if you if I we have you know we're seeing doctors all the time because kids and stuff like that so generally speaking the PPO will be preferable for us even at a higher premium because we're in there quite a.

Bit now that might be and the the instance where the insurance having insurance me vibes you to go see the doc more so because you have insurance like well I better use it I don't want to lose it a section but yeah at the end they I don't know but that's that might be the way the insurance is incentivizing us to go.

Actually see the doctor more you know you got a sore throat we're gonna doctors not quite like that but you don't say any me guess or there I better use their insurance ago the doctor as he was another good use of insurance insurance is supposed to be forecast traffic coverage but be it as it may that's the difference there so I hope.

You like what you see stay tuned for the next one we're going to show you how you figure out what your own Cobra payment would be it's actually quite easy so stay tuned and don't forget to subscribe thanks down
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