California Health Insurance Types

Preferred Provider Organization (PPO) allows plan members to refer themselves to doctors of their choice, including ones outside the plan. A (PPO) has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the insurer for their services. As a result, your cost sharing should be lower than if you go outside of that network.

Advantages

• You can choose your own doctor or hospital.
• You do not need a referral from a primary doctor to see a specialist.
• Health care providers usually compete for your business and provide a higher quality of care.

Disadvantages

• Your out of pocket expense usually is higher than HMO plans.
• You may not receive a discounted contract rate if you use a non-member healthcare provider.

Health Maintenance Organization (HMO) does not allow self-referral to a specialist or healthcare provider other than your primary physician. HMO plans offer members a range of health benefits, including preventive care, for a set monthly premium and small fee when care is provided.

Advantages

• Your out of pocket medical expense is usually small compared to PPO plans.
• Good plan if you’re healthy and limit your visits to the doctor annually for physicals. In the event of a major illness, accident or condition, your out of pocket expenses may be lower as long as you stay within your HMO network of doctors and facilities.

Disadvantages

• You need to choose a primary physician to receive care.
• You will need a referral from your primary physician to see a specialist.
• Since health care providers do not have to compete for your business you may receive a lower quality of care or service.

We recommend you contact us and we can give you suggestions and let you know which plan type would be more suitable for you.