in ,

[Solved] What Is The Difference Between Hmo And Traditional Health Insurance?

Traditional insurance usually allowed a policyholder to obtain treatment from any medical provider 😉 The insurer would then agree to pay a certain amount, and if that was not enough to cover the provider’s fee, the policyholder would be responsible for paying the balance 😁 In order to cut costs, insurers began to enter into contracts with providers in advance, in which the providers agreed to accept a discounted fee in exchange for being listed in the plan’s provider network 🙈 Some plans encourage their policyholders to seek care from these “preferred providers” by paying less for care given by non-preferred providers. Some plans simply provide that there is no coverage for care outside of the plan’s network. This type of plan in some ways resembles an HMO. [1]
A defining feature of HMO and PPO plans is that they both have networks. Networks are one way to lower health care costs – network providers agree to give discounts in exchange for access to a health plan’s members. This saves health insurers money, but it also saves health plan members money as well – savings for the insurer can translate to lower premiums, deductibles and copays. In general, PPO networks tend to be broader, including more doctors and hospitals than HMO plans, giving you more choice. However, networks will differ from insurer to insurer, and plan to plan, so it’s best to research each plan’s network before you decide. (we give thanks to Neilson Kendall from Mar Del Plata, Argentina for their revision). [2]
Image #2
PPO, HMO, POS, EPO… That’s a lot of three-letter acronyms. Generally, when talk about insurance plan types involves acronyms like these, we’re breaking down managed care plans by the type of provider network they have. Managed care plans are different than traditional health insurance plans, where you’d see any doctor you wanted, pay the doctor, and be reimbursed for a portion of the’s havingad costing of care. Managed care plans try to control costs while maintaining quality of care. One way to do this is to build a network of providers that agree to accept lower fees in exchange for access to patients in the network. Because health care costs continue to increase, managed care plans and their cost control measures have become increasingly popular. Below are some common network/plan types. (modified by Beverly Taylor from Xintai, China on May 13, 2021) [3]
Sandi Boston from medmutual.com, describes how like an HMO plan, PPO plans also feature a network of doctors and hospitals you can visit. Similar to an HMO, PPOs have provider networks to save on health insurance costs. Providers in the network agree to accept lower payments in exchange for access to patients in the insurer’s network. Unlike HMOs, however, PPO networks do provide some coverage for out-of-network care. Using a provider who is not in the PPO network will still be covered by your health plan, but you will likely have to pay more. You will have the lowest out-of-pocket costs if you use an in-network provider. (last edited 84 days ago by Mariann Parrott from Banjarmasin, Indonesia) [4]
A PPO offers another kind of provider network to meet the health care needs of consumers. A traditional insurance carrier provides the health benefits. An insurer contracts with a group of health care providers to control the’s havingad costing of providing benefits to consumers. These providers charge lower-than-usual fees because they require prompt payment and serve a greater number of patients. Consumers usually choose who will provider their health services, but pay less in coinsurance with a preferred provider as compared to using a non-preferred provider. With most PPOs, insureds can self-refer to specialists for care without first having to visit their primary physician to get a referral. (last emended 10 days ago by Jamae Finch from Qingzhou, China) [5]
References:1. HealthCare.gov. Retrieved from https://www.healthcare.gov/glossary/health-maintenance-organisation-hmo/. Accessed on February 10, 2021. 2. HealthCare.gov. Retrieved from https://www.healthcare.gov/glossary/preferred-provider-organisation-ppo/. Accessed on February 10, 2021. 3. HowStuffWorks. Retrieved from https://health.howstuffworks.com/health-insurance/provider-network.htm. Accessed on February 10, 2021. 4. Verywellhealth. September 2020 Retrieved from https://www.verywellhealth.com/hmo-ppo-epo-pos-whats-the-difference-1738615 5. UHC. Retrieved from https://www.uhc.com/understanding-health-insurance/types-of-health-insurance/understanding-hmo-ppo-epo-pos. Accessed on February 10, 2021. 6. UHC. 2020. Retrieved from https://www.uhcprovider.com/content/dam/provider/docs/public/health-plans/medicare/MA-Referral-Required-Plans-FAQ.pdf. Accessed on February 10, 2021. 7. ValuePenguin. January 2021. Retrieved from https://www.valuepenguin.com/average-cost-of-health-insurance 8. HealthCare.gov. Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/. Accessed on February 10, 2021. 9. Medicare.gov. Retrieved from https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/are-prescription-drugs-covered-in-medicare-advantage-plans. Accessed on February 10, 2021. 10. UHC. 2020. Retrieved from https://www.uhc.com/employer/health-plans/dental. Accessed on February 10, 2021. 11. KFF. October 2020. Retrieved from https://www.kff.org/report-section/ehbs-2020-summary-of-findings 12. NCQA Health Insurance Plan Ratings 2019-2020. 2019. Retrieved from https://healthinsuranceratings.ncqa.org/2019/Default.aspx 13. HealthCare.gov. August 2020. Retrieved from https://www.healthcare.gov/blog/open-enrolment-2021-dates/ 14. Medicare.gov. October 2020. Retrieved from https://www.medicare.gov/blog/medicare-open-enrolment-get-ready 15. Medicare.gov. March 2020. Retrieved from https://www.medicare.gov/blog/medicare-advantage-open-enrolment-2020 16. SSA. Retrieved from https://www.ssa.gov/policy/docs/ssb/v37n3/v37n3p35.pdf Accessed on February 10, 2021. 17. FinancialWeb. Retrieved from https://www.finweb.com/insurance/4-types-of-health-maintenance-organizations.html. Accessed on February 10, 2021. 18. HealthCare.gov. Retrieved from https://www.healthcare.gov/glossary/point-of-service-plan-pos-plan/ Accessed on February 10, 2021. 19. OPM. 2020. Retrieved from https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-types/. Accessed on February 10, 2021. (edited by Adam Cruz from Sorocaba, Brazil on January 26, 2021) [6]
Pocketsense.com goes on to explain that under managed care types plans, you usually have a more limited choice of health care providers than you do with a traditional medical plan. Customarily, with a traditional medical plan you can choose your providers. With a PPO managed care plan, you can usually choose from among members of a participating network of providers and hospitals and receive a preferred rate. You may be able to utilize a provider who is outside the preferred network, but when you do so you may forfeit the preferred rate. With an HMO, you are usually limited in choice to seeing one primary provider who provides referrals if needed to other HMO participating providers. If you want to see a provider outside your HMO, you will likely pay for it personally. [7]

Article References

  1. https://www.ehrlichfirm.com/hmo-faqs-compare/
  2. https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance-Education/Compare-Health-Insurance-Plans/HMO-vs-PPO-Insurance.aspx
  3. https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance-Education/Health-Insurance-Basics/Types-Health-Insurance.aspx
  4. https://www.medmutual.com/For-Individuals-and-Families/Health-Insurance-Education/Health-Insurance-Basics/Types-Health-Insurance/PPO-Health-Insurance-Plans.aspx
  5. https://www.ahinsuranceservices.com/traditionalvsmanagedcare.html
  6. https://www.healthmarkets.com/content/difference-between-hmo-and-ppo
  7. https://pocketsense.com/traditional-vs-managed-care-plans-8000583.html
Kelly-Anne Kidston

Written by Kelly-Anne Kidston

I am a writer of many words, from fiction to poetry to reviews. I am an avid reader and a lover of good books. I am currently writing my first novel and would love to find some beta readers who are interested in getting an early look.

What Is Marian Anderson Known For? (SOLVED)

(SOLVED!) Did Jackson Pollock Sign His Paintings?