If you’ve been confused about the varieties of coverage and their features, you aren’t alone. Good news: We can help! To save you some time (and lost hours), let’s break down some common acronyms – PPO and HMO– that you may encounter when enrolling, their features and how you might consider using them. While you may not have all of these options, it’s always a good idea to be informed and ready.
(Remember that more details on these acronyms and many additional details about your benefits can be found in our Summary Plan Description, or SPD).
What is a PPO?
A Preferred Provider Organization, or PPO, is a group of doctors and hospitals that provide comprehensive medical services and in exchange, your out-of-pocket costs are lower when using providers that are within that particular network. PPOs offer both in-network (those providers that a part of the network) and out-of-network (providers who are not part of the network) coverage.
- PPOs offer flexibility for receiving care without needing a referral. This is important if you value choosing a specific health care provider or specialist, regardless of network status.
- PPOs will often have lower costs when you see an in-network doctor, but you’re still able to see any provider that isn’t in network. This is important if, for example, you need specific or specialized care, and you’re unsure if your provider is in or out of network.
What is an HMO?
Another common “O” benefits plan is a Health Maintenance Organization, or HMO. Under this plan, care is usually limited to health providers within the network and require referrals should you need a specialist. These are popular plan choices, however this may just be one option available to you depending on the provider.
- HMOs will usually have low out-of-pocket expenses. This is important if you value cost savings on your monthly premiums and related expenses.
- HMOs have partnerships with various doctors and hospitals within their provider network. This is important if you value keeping your regular physician or preferred health care facility.
- HMOs require referrals to see specialists. Keep this in mind, if you need to see a specialist who would be referred by your primary care physician (PCP).
Other Os You Should Know
PPOs and HMOs may be the most common benefits options, but there are others that you might encounter.
- Open Access. This is a provision that is available with some plans. If it applies to your plan, it allows you to see any doctor in the network, including specialists, without a referral. Open Access is often a feature that’s associated with traditional HMOs.
- Point of Service (POS). Similar to a HMO, a POS offers coverage for medical care that comes outside of the network without required referrals. In some cases, a POS plan is included with Open Access.
- Exclusive Provider Organization (EPO). Similar to a PPO, an EPO is also a group of hospitals and doctors that provide comprehensive medical service. However, EPOs only provide coverage when eligible health services are received from those providers that are in network, with exception to emergency care.
Good to Know Before You Enroll
Making an informed decision on your benefits is an important factor when it comes to enrolling.
While this article helps in giving you a bit more information about the different plan options, you should always review the additional details that come with each medical, dental and vision benefits plan.
When it comes to benefits, no size truly fits all, which is why you should make sure that the plan you choose is able to keep pace with your current and future lifestyle. If you need additional support or you have questions, give our award-winning MyLife Advisor team a call at 844-448-0325.