Selecting a benefits health plan for your team is an important decision. The benefits you provide impact employee retention and satisfaction. Decisely is here to help you choose the best solution for your company. Two of the most popular plans are PPOs and HMOs. The biggest difference: PPOs have greater flexibility, HMOs have lower costs. Keep reading to learn more.
HMO stands for Health Maintenance Organization. Subscribers of HMOs choose their doctors from a network of approved providers. That means lower premiums and lower copays because these doctors are in-network. Cost savings is a huge plus.
On the flip side, HMOs require referrals for subscribers and their dependents to see a specialist. Say you visit your primary care physician for your annual checkup. During the appointment, the physician notes they want you to see a cardiologist. Your primary care physician acts as a gatekeeper and must refer you before you can see a cardiologist (or any other specialist). The important thing to remember with HMOs is you want a primary care physician that you trust as they serve as your advocate in the network of covered providers.
Depending on the HMO, these plans can cover additional services such as cancer screenings and x-rays
In a nutshell: HMOs cost less, but your choice of doctors is more limited.
A PPO stands for Preferred Provider Organization. With a PPO, you have broad access to different kinds of health care providers. In exchange, a monthly premium must be paid. This premium can either be taken care of by the employer or can be deducted from the employees’ pay stubs.
With a PPO, you do not need a referral to see a specialist. This greater flexibility also has the potential for higher out-of-pocket costs (for doctors that are out of network). For in-network providers, the cost is far lower.
In a nutshell: PPOs provide access to a wider network in exchange for a monthly premium.
In More Detail…
|Do your employees need to designate a primary care physician?||Yes||No|
|If a doctor or specialist is out of network, is coverage still provided?||No, HMOs do not offer coverage for doctors out of network.||Yes. While there may be a higher copay, PPOs allow visits to any doctor, in or out of network.|
|Do your employees need to file a claim for their care?||No, because the insurance provider pays in-network doctors directly.||Yes, when a doctor is out of network.|
|What’s the cost?||Lower premiums||Higher premiums|