Health Insurance

There are a lot of decisions to make when it comes to choosing a health insurance plan. One of the first decisions you will need to make is what type of policy is best for your current situation.

You’ve probably heard the terms HMO (health maintenance organization) and PPO (preferred provider organization), but what’s the difference between the two?

WHAT IS AN HMO?
HMOs have a network of doctors, hospitals and other healthcare providers who provide their services for a specific payment. This allows the HMO to maintain the lowest possible costs for its members.

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket, but you will be limited to doctors within your network, specialist visits require a referral and many prescriptions for common conditions, such as migraines, require prior authorization.

With most HMO plans, all of your healthcare services, referrals and prior authorizations are coordinated by your designated Primary Care Phyisican. HMOs don’t offer coverage for care from out-of-network healthcare providers. The only exception is for true medical emergencies.

Since HMOs only allow you to visit in-network providers, it’s likely you’ll never have to file a claim and your insurance company will pay the provider directly.

WHAT IS A PPO?
A PPO offers you a network of healthcare providers to use for your medical care at a negotiated rate. However, unlike an HMO, a PPO offers you the freedom to receive care from any healthcare provider — in or out of your network and a referral is typically not required.

PPOs tend to have higher monthly premiums, but in exchange they allow you the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan since referrals and prior authorizations are not required.

PPO plans do not require referrals and you are not required to coordinate care through a Primary Care Physician. With a PPO, you have the flexibility to visit providers outside of your network. However, visiting an out-of-network provider will include a higher fee and a separate deductible. In some cases, you will have to pay for services directly and then file a claim to get reimbursed. This is most common when you seek services from out-of-network providers.

WHICH ONE IS RIGHT FOR YOU?
An HMO might make sense if lower costs are most important and if you don’t mind using a PCP to manage your care. A PPO may be better if you already have a doctor or medical team that you want to keep seeing, but who is not part of your network.

If you’d like to talk about your health coverage options, or you’re ready to sign up for a plan, please reach out to us at (760) 271-6651 or via email.

1. Primary Health Insurance
There’s no question that basic health insurance plan is a critical piece of your health and wellness puzzle. With open enrollment just around the corner, this is the perfect time to do your homework about that kind of coverage is available and then connect with your agent to find

There are still enhanced subsidies available through healthcare.gov, you may have new offers from your employer and your agent will know how to get you the best pricing on the most coverage. Be sure you and your family are covered, that you can afford the monthly premiums, and that you keep your out of pocket expenses as low as possible.

2. Secondary Health Coverage
You may want to need to consider adding a supplemental health plan like accident or indemnity insurance. These will help you cover costs related to ambulance rides, radiology and non-prescription medications. These policies are relatively inexpensive and can also help with loss of income while you’re out of work due to illness or injury.

3. Vision Insurance
Vision Insurance is not typically part of your health insurance policy (this may be different for children under the age of 18). Annual eye exams, like most preventive care, can help you identify and solve vision issues before they become severe. Most vision coverage will include an annual exam, coverage for all or part of the cost of glasses or contacts, and may include important things like eye surgeries.

Things included in your vision plan can vary dramatically from plan to plan, check with your agent to make sure you’re choosing the plan that best fits your needs and your pocketbook.

4. Dental Insurance
Dental expenses are not typically covered by your health insurance (this may be different in the case of children). Unless the dental problem arose from an accident or is life-threatening, you will need to use your dental plan or pay 100% out of pocket.

In many cases, bundling your dental and vision insurance can save you money. Be sure to ask your agent about how bundling can save you money.