Understanding Your Coverage

It’s easy to find yourself confused by the medical insurance jargon you may encounter when trying to choose a health insurance plan. Familiarize yourself with the basics to help you find the one that best meets your needs.

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HMOs vs PPOs

A Health Maintenance Organization (HMO) is a type of managed care health plan where members choose their physician from a list of approved health care providers, which typically results in lower premiums and/or copayments. Generally, members of an HMO can only see a health care specialist (obstetrician, cardiologist, rheumatologist) if they get a referral from their primary care physician, HMOs tend to provide the least expensive medical coverage and a minimum amount of paper work. However, your choice of physicians may be more limited.

A Preferred Provider Organization (PPO) is a managed care health plan that gives its members multiple choices in health care and health care providers. You or your employer pays a monthly or quarterly premium for coverage of a broad range of medical services. Like an HMO, a PPO may charge a copayment for each office visit and there is usually no paperwork to complete. The network of physicians is often much larger than an HMO and members can refer themselves to physicians outside of the network, although you may pay a higher copayment for this service.

Click here to learn more about the difference between HMO and PPO plans.

Health Insurance Premiums

An insurance premium is a set amount that you pay for your health insurance coverage. As a part of an employer-sponsored health plan, your premium is usually deducted from each paycheck. Health insurance premiums vary depending on the insurer, the type of insurance plan (HMO, PPO, POS or FFS), and how much your employer contributes towards your coverage.