PPO Vs. HMO: What's the Difference and Which is Better?
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- čas přidán 12. 10. 2015
- Next Step: Take the PPO Vs. HMO test for yourself - www.giangolainsurance.com/heal...
What Does PPO Mean?
PPO stands for Prefered Provider Organization. This type of plan offers a higher level of reimbursements when you receive treatment from a “preferred” doctor or hospital.
In less fancy insurance terms, you pay less.
This is also known as your health insurance company’s network. These “preferred” providers offer their services to you at a cheaper rate if they’re in your insurance company’s network. You even have the ability to see non “prefered” doctors with this plan, they are just consider out-of-network doctors.
PPO’s have dominated the health insurance landscape for the last 10-15 years.
What Does HMO Mean?
HMO stands for Health Maintenance Organization. This plan type works a little different from a PPO.
Instead of being able to choose from a list of doctors at a wide array of facilities, you are strictly limited to doctors and facilities contracted with that health insurance company.
The goal of this plan structure is to have a primary physician manage your care. The most famous example of an HMO structure is the company HealthSpan, formerly known as Kaiser Permanente.
These plans generally are less expensive than a PPO plan, however that is in exchange for a limited selection of doctors and hospitals.
Let’s Take a Closer Look
So I’ll ask you again, how many doctors do you want to be able to see if something really bad happens?
The answer to that question is the answer to your internal PPO vs. HMO debate.
But if you want to go even deeper, here’s what you need to think about.
When does a HMO plan Make Sense?
This is a hard question to answer since it will always come down to personal preference.
But, this is how I like to explain it to clients.
If there is a HMO plan that has doctors close to your home that you like and trust and also has an adequate number of hospital facilities, that’s a decent first step. You also need to be able to save a considerable amount of money on your health insurance payment every month.
Finding both of those together is the tricky part. I have yet to see a HMO plan that offers enough savings to consider recommending one to a client.
When you only save a couple dollars every month, you have to ask yourself if it is really worth it to limit yourself that severely when it matters the most.
I've never been able to answer yes to that question for a client.
Growing up requires me to ask these kinds of questions.
Adulthood SUCKS...
Thanks for making this understandable.
Happy to help Thalia.
SUCKS BIG TIMES
I will second this haha
The US healthcare system is the one that sucks big time!!
damn yeah
Fascinating to learn about the horrendous US healthcare sysyem... It's all bad
right to the point
DPPO's are better than DHMO's at least. I know from experience. Since there is no cap, the dentist will charge whatever, whenever under DHMO's.
The worst. horrid. almost pure evil.
HMO driving problem is their primary interest is to reduce their cost and liability instead of making sure the patient is correctly diagnosed and treated in a timely manor, they will string you out while condition deteriorate with no consideration, and you must fall in a waiting line amongst a huge number of other people to gain access to limited specialist after you manage wear the primary down to make the referral, ppo you can choice from a wider pool of primaries and specialist, and you can go straight to the specialist without referral, and not have to wait or be dicked around
Your health should be the number one priority. Keep that machine running smoothly. Most people i know would spend more on their car than their health.
Just stumbled across this video. Confident voice, clear information. You were engaging while keeping your explanation efficient. Great job!
Thank you for this information. Now it makes sense for me to keep my PPO. And you made it happen.
Thanks for sharing such great information. It is really helpful to me. I always search to watch the quality content and finally I found your post. Keep it up, keep posting!
you should teach Insurance at my university... our teacher NEVER puts things into layman's terms );
Thanks, I appreciate that. Anyone that doesn't teach you to talk insurance in layman's terms is too concerned about sounding smart.
This is the trauma my family is going through right now. My father opted for an HMO from Aetna because there was no payment required. February 14th he slipped from his bed uninjured and asked to be taken to the hospital from the EMS. Worse decision he ever made. He had no injuries except diabetic ulcers he wanted to be looked after. After six days in the hospital, Aetna sent him to a subacute rehab facility. Five hours of physical therapy out of the entire week in a bed and wheelchair. He left weaker, having difficulty to walk and get up from a seated position without help. We asked the facility we hoped therapy would strengthen him to get up from a prone position. Zip ahead three hospital visits and two subacute facilities later and Dad is completely bedridden, racked with horrible arthritis in his hip and knees, cathetered (without the family knowing) from his second rehab stay and saddled with horrible bedsores that required a colostomy and the bed sores being torn out of him. He almost died the day after Easter and he was a super high risk for the duel colostomy / bed sore surgery that took over three hours. Dad is now in a daze from the medication and malaisse from being away from home for almost half the entire year. The surgeon recommended an acute facitity for Dad but Aetna HMO went once again to a sub acute facility with yelp reviews stating how understaffed they are. Both my first and secondf appeals for his multiple stays were denied. DO NOT SIGN UP WITH AETNA HMO!!!! These idiots release patients worse than they went in and then spend extra money on visiting nurses, therapists, supplies and doctors afterwards that only spread the patient's continual decline. Dad was just released from his fourth hospital stay to go to a subacute facility after the surgeon stated it would take three months form his bed sore wound to be completely healed. If Aetna HMO keeps to it's prior practice, Dad could be cut loose at 20, 16 or 14 days. NONE OF THIS HAD TO HAPPEN!!!!! But try telling that to Aetna or Livante; the company that handles Aetna's appeals. Those bastards will see my father dead. STAY AWAY FROM HMOs!!!! Take it from experience. It has destroyed the family watching my father suffer and decline in health the way he did. And the man was sharp as a tack. With all the trauma and drugs for his operation and subsequent infections, he is confused and disoriented. Since February 14th I have alternated between alcohol and sleeping pills just to sleep. No kidding; please take my tesimony seriously. You do NOT want to experience a family member falling victim to "the system".
Is Aetna a good insurance?
If you can afford a PPO and have the right to choose, please always go with a PPO.
wrkin90044 In order to get the closest possible thing to full coverage under the private healthcare plan in the US market is to have a Platinum PPO primary plan as your major medical insurance policy, with an additional but still necessary fixed indemnity reimbursement health insurance policy that acts as a supplement to your primary insurance policy.
I looked up the prices and found out that a 73-year-old immigrant without a green card yet would have to pay anywhere from $750 a month to $2000 a month for Platinum PPO primary insurance policy, and at least $100 a month (or probably far more) for the secondary fixed indemnity insurance policy to make up the difference in cost not covered by the primary insurance policy. Of course, that is considering such an individual is even accepted despite his status, regardless of whether or not he can afford it.
Clicked on his face, instruction unclear, his face is now my lock screen.
The truth is that a good doctor makes a huge difference. I have to very healthy children, one a ballet dancer and the other a drum core DCI percussion musician. Both need to see a doctor for their overused feet, tendon etc. One of the best doctors in Michigan take care of what he calls "elite atheles," and his experience and suggestions are what you are looking for.
My daughter had a problem with pain in her legs when she was little and was in point. He looked at her and in five minutes of this child walking, and he gave a diagnosis. And also told us to find a physical therapy who trully understand "dancing."
Now, my daughter goes once every six months to the sports medicine at the University of Michigan for maintenance.
And while both of them are doing fantastic, there are a lot of young dancers that I know that have lingering problems with their legs because the parents used the traditional doctor, and the HMO health provider physiotherapist.
One of the things that nobody talks is that because the doctors and physiotherapist are in contract with the HMO, they can not say they ...DO NOT KNOW, NOR THEY DO NOT HAVE THE EXPERTISE," specially if that is a referral, like with physiotherapy, and continue with practices that are not the best for the patient.
My son has flat feet. And I can tell you the enormous difference between a doctor in the HMO program doing my son's insoles, and this best Dr. doing the insoles...day and night, and I paid around $200 dollars for each pair of insoles.
So, cost is very important, but quality when you really need is the question. At least for my children made a huge difference.
I work with BCBS Florida blue line and I come across a lot of members who have hmo. We only take imboud calls from the member and we transfer providers. I'm still learning the system I'm in training right now, your video was helpful to me learning the difference between the two.
Thats why im here! I work for bcbs of Georgia but i take member and provider calls... But our HMO plans work like a PPO mainly because we have open access plans.. Where our members can see any doc they choose
Thanks for your help brotha.
No problem Keith.
Aw
Are the PPO and HMO list of doctors the same except with PPO you can go outside of the list for a higher price? Or does PPO have a bigger or better list of docs? Thx
I have an Atnea plan that's called an HMO D-SNP, it's primary is an HMO, but the dental has it's own PPO within the plan.
U dont realize how lucky we are to have insurance
I have blue anthem cross ppo from the carpenters union best insurance out there
Blessed
Awesome explanation
You great during speaking from past and now the client has been suffering a lot of problems such as accessibility, low quality, increasing cost and low of trust in insurance organization. Are there problems creating. Is there alternative...? Are MHCOs there a need to be reformed ? What are you experiencing for MHC concepts and practices?
Are the clients have full satisfaction? If you upgrade articles pls provide me to learn more.
Thank you
I'm trying 2 look for a dental plan for adult. Aetna ( $150 for a year) gives u discounts ( 15%-50%) seems good however this is so confusing, I don't even know if that falls under this video Hahaha
where do EPO plans fit in with HMO'S & PPO'S?
TY very helpful..
Gracias senor!
What if your HMO also comes with an HSA? Doesn't that help incentivize it?
I have tufts health together, which is a Masshealth plan, specifically Masshealth care plus. Just wondering if it’s a poi or hmo
Wouldn't it be less costly for someone having a baby to be on an HMO plan?
What if a doctor is not in network but says they do accept the insurance. Would I pay less or more?
Not bad. But I would LOVE to hear actual OPINIONS of what real humans think of both! Because the “differences” are explained clearly on every insurance handout one gets when signing up!
Subscribed!
Thanks Brittney.
Also.. you can go see a provider in your dhmo plan BUT if you don't set up the person your seeing as your primary care dentist.. you won't see the cost savings shown in listed benefits. They'll just accept you and charge you like anybody else.
We (my wife and I) are on the Medicare Andvantage PPO plan. In Michigan we use the Henry Ford Hospital or Clinics - No problem and we are OK with it. My question is if we are in Florida where can we go when needed for the same as in Michigan? Thanks
thank you :)
I love the strat 😁
For me there's no point of having ppo in my city because my doctor and hospitals in my health insurance network is far from me. My doctor want me to go see a specialist that is 35 minutes drive from me , and to do lap works and everything else is far in different places. i currently have blueshield of california ppo ,but i just switched to kaiser permanente hmo , and will start with them in July. There is 2 kaiser facilities in my area within 4 miles from me. kaiser have almost everything i can do in 1 building.
There is no right or wrong answer when it comes to choosing a PPO or an HMO. It's all about what fits your needs. The only potential danger HMO plans presents is that you could possibly find yourself in a situation where can't get the treatment you want or need. The holes in the safety net are a little bigger.
"coming back like roller skates"
use that :)
Can u have both?? My job I’m at now I receive Ppo threw them but just got hired somewhere else that offer HMO, I want to keep both jobs just wondering if I can get both or what will happen… someone help me!!!?????
Housesitting I’ll pay for $2000 either way ago I had both him and the doctor called him to change a PPO Lizzie and a BTTAL is the quality complete and I’m sick of any vans if I wanna do you ever do is it because my dad’s here he say when you say I’ll go to see everything you’re doing now
I actually clicked on your face, twice.
I’m shopping insurance and ppo plans keep coming up cheaper than hmo. Why?
It's such a scam either way. It's about at the point where avoiding insurance and just accepting the debt if something happens makes more sense. You'll get treatment either way, and then just pay the debt as you choose, if you choose, instead of letting these unethical companies pound you in the rear every paycheck.
Anthem blue cross PPO one of the PPO's you'd say to stay away from?
Cigna PPO offers catastrophic event PPO insurance in Clark County, NV, for as little as $103 per month. Anthem Blue Cross Blue Shield in the same area offers the same type of insurance for $223 per month. I am not sure about the details regarding the deductible, coinsurance, copayment, maximum out-of-pocket costs, or annual policy coverage limit (which is supposed to be at least $2 million). However, PPOs will cover at least 50% of the coinsurance costs in-network or out-of-network, and in-network coinsurance coverage of at least 60%.
Nuclear Armament do you sell Cigna?
I see less physicians but the visiting "out of network" & "non preferred" physical should've been informed by the medical billing specialist that my medicare supplemental insurance doesn't cover his service. Now I have a out-of-pocket expense of $1100 for 2 bandaids & a prescription of antibiotics.....a " copay " that's billed 4 months after I visited the Er walk-in that's in my network shouldn't surprise me with a $995 bill for a out-of-network physician interviewing me after a nurse practitioner takes my vitals. ..this isn't legalized robbery by the medical billing specialist. This is just a savage practice of cash grabbing and putting liens against out SSN's & ruining people's credit scores
So if I see a doctor regularly for pain management, with spinal stenosis, which plan is best for me?
The HMO would be significantly cheaper for me.
If you have a great specialist I would keep whatever plans allows you to keep him
coming back faster than game stop stocks
HMO suck because if you have a serious disease like cancer you cant really go to one of crazy expensive treatment centers you see on TV. You get stuck with the bare minimun treatments.
Both premiums increase every year, both have thousands of dollars of deductibles, both suck!! the whole HC system sucks
OH my God Joey Giangola Your PPO sands like a Floot.
First curve ball of my adult hood
Any of those options aren't good, they have so many concerns that are not advisable. Consumer protection is always implemented worldwide, protected from FRAUD. Better have a DISCOUNT card that is best above the rest, that does not exaggerate its promos. SMEs........,.respectively.
🤣🤣🤣 love this
Some misinformation you gave about Kaiser. They did not change their name in Ohio they were bought out and the new owners name is Health Span. Kaiser is unique in health care it is not a traditional HMO. The doctors are employees and have no reason to over treat or deny any services to a member. Doctors enjoy the fact they can practice medicine without any restrictions. Kaiser operates their own hospitals and pharmacies and labs so they are in total control of your heath. They invented electronic medical records going back to the 60s. They have a very high retention rate of members many of whom stay with them their whole life.
Corn cob united health care
Yeah I had a boat
Boy bands if you're an American who likes kpop (is the fastest comeback)
Lisa can't say they are my first choice, but that's good to know, I think...
Prominence HMO in Amarillo, Texas sucks
There needs to be more nurses and Doctors who. are third or fourth generation Americans who speak English without a thick.accent which I can't understand and find annoying.
Maybe his msg is important But the Quality of delivery it is very poor
Joey Giangola more Like Joey Pringul.
What are you gonna come back and talk to Mismo say go nowhere where are you baby and I told you 101 now
I have both of them with the Medicare people it was a PPO I never used it so can I have my money I use my husbands hospital insurance with the PPO is it has been fed I was 60 to 70 will be there in 2018 all the time you always get my money and I was using that as my primary insurance I could use your Medicare card is yours so can I get some money back I need it can you close your mouth you know some meals for God bless you
My doctor gave me the best OK I have HMO but Dr. Kye mobile Mid-America do don’t look at me with your mouth wide-open like that you make me laugh do you think is him is when people tell me it is medically and all this kind of stuff I need some teeth do you know if I’m gonna have any you you’ll lose all your teeth you will be in the same situation when you get married I promise you now I promise you where’s my money yet since I was 55 years old I never use my medication with where is it it I’ll take it out of my bank I use myI’m not done talking to you or you spell close your eyes it’s gonna be like that make me laugh I use my hospital my husband hospital insurance and before that I use my own hospital insurance now I never been sick when my money will you give it to you take care of these other people with money are you gonna be with you so now I don’t need to say I talk to the main Medicare lady she was a good lady she wasn’t lying cheating thief she said the dealership open with a quarter yoga is why you go on the net worth why because you think this is like you said people to them now and yeah I don’t pay no more than what you’re gonna say you gonna pay for $2000 and go with your teeth cleaning all that free x-rays free I have no tear meI’m not done talking thank you for looking up at me I’m talking do you know why I paid Dylan’s House $2000 my bill what was there is 3200 I wonder if I am going to same price you have a pet animal in 2000 out you did x-rays and I’ll see you in a bit I’m down the street do you have a Denist area I need some teeth I need my money but I’ll get it from Blue Cross and Blue Shield from United Health Care seeing more AR use Medicare I use my husband’s hospitalization with where’s my money yet do you hear me talking to you now you can talk
PPO IS A CHANEL CZcams
PPO all day
No joke here’s a first come back if I don’t get to go you put the money saving money for me same for me is my money but I thought it first when I went to see in your game that’s OK don’t go to the Dennis all this year I want is called a clean XPO they want to x-ray is in yellow wire go x-rays are free but I got a game you get your own network does them to the network and yeah I don’t pay no more yelling about him all the windows are y’all gonna be I wanna talk to you more however briefly but you keep your tea but you Gotta be like me hey what now
No I went to the dentist Monday I didn’t have a father she’s a nurse she sent me to this file of appointment with another Denist when she did x-ray me instead she said that I had cracked tooth and my two tooth I did my dad come out and put it there lose weight as I have it in my front teeth because my partner violence wanna talk about it right now baby I’m talking to Martin now I shouldn’t have to suffer are you going to supper to now SPI can speak anything with anybody I want to where is right and wrong is well checking his people tell the truth you’re allowed to pay what you do Medicare people why they can’t work I got free as he has it in me and Medicare I can go get a job but I do best in him
I told you I got word would you just say that you see what you just said no matter what I say she can switch me back to the PPO happy be OK they would have the truck at $2500 but now you put me on is it United Health Care aquatic complete HPOCSNP and I’ll be able to thousand thank you ladies for dinner please say he’s a talk to the governor know that there are a rollover are you allowed to send me a check at the end of the year I’ll go to the doctor because y’all got my homeboy yeah one of the hand for eight dollars it was that it was delivered via being on for fall never use
That waste my time God bless you
Those tacos and one to come back and talk to him as a mole and don’t be sending me no letters to my house please now I was at my doctors office right away I went to the dentist in America to my day. $2500 for dinner come on the people to be another man that they gave me the number so my pay they pay $500 they even have a dad but it’s not the x-rays on my God $99 but now you go to this area is free but what is Manny is $99 Siri game people God bless you but I made it out
More or FEWER doctors. NOT less doctors. Sorry, I teach ESL.
No e
I read that horrible is where the same time I show my sweetheart I wish you came out here and my doctor changed with the HMO how do you spell it time for bed for bed because I will tell my dad about telling you I have no problem going to the doctor my doctor takes care of me and I’m so much Denist the lady down at Cythinya’s at work at the Dennis Medicare and she say that we need to talk to the governor no yeah I need to say to save people money I had to go to the doctor last year so I know I wanted to thousand dollars in rollover no y’all take it and put it what are you doing what you do it where is it is it was real values away is all the money can you answer the question then Robin Hood different way to give it to the boatI have a speaker for myself but I will speak up and nobody yeah I just want to people
That’s exactly thousand nurse I go to inject in the world I want to go to because I know my dad does not like yo I have a debit do that now well I am at Tara bleeding and stuff like that and they need to be another pill or less the added here no problems I had insurance but I need no problems now with the black with the Medicare people you’ll meet people think I have it on me only have nobody now
LLLLLLLLLLLLLLLLLLUIIIIIIIIIIIIIIIIIIIIIIIIYYYYYYYYYYYYYYYYYYYYYYYYYYYYTTTTTTTTTTTTTTTTTTTTSSSSSSSSSSSSSSSSSSSSAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAFFFFFFFFFFFFFFFFFFFFFFFFRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRTTTTTTT MJK
Popeyes making a fast comeback
Add close as I’m talking to you I got HMO I got the united healthcare chronic complete and I’m not even here thank God my doctor to change it to the clinic complete so if I do get here would you go during your rubbers did you along time ago say when I was younger but I will start working to say around when I got my Waze is around now it is Medicare I got to be straight now oh yes and people all his Medicare card say what you’re gonna do what you Gotta do what you Gotta do OK with her at six flags if you put them over here I’ve been on it since I was 55 so where is all my money to take her in for four and 508 editor without you
Bro what?
I got a GMO don’t look at me like that with your face hot looking lady come on boy all the stuff and I’ll be Sam you said land people they don’t send me that yes that y’all got a game with your net worth you send me that you came to thousand dollars but then I got to be always has one one day and told me $3500 one Denist told me I had to pay 800 in Jago. They had it I’ve been everything is up and down the street there’s this winter and why did why did you just pull my teeth because I want to train you add more money yeah I got a pay you got my money go back and pull your records seven times I’ve been in the hospital how many times I paid insurance I didn’t use
What mmmmm
No y’all send me to the Internet work I have PPO to come on baby don’t believe me that’s your mouth wide-open I got a put your foot it over your head and these people I need to get Sonia she made me except at 10 years old her she can helium stroke five heart attacks he’s 62 years old and she can’t even get another Social Security number they can stay America nothing yeah I got a game man I hope you get these messages call me I like talking to people yeah I did the Denison meal
HMOs fluffing suck!!!
HAVE YOU LOOKED AT WHAT THE DEDUCTABLES ARE LIKE IN A PPO THIS YEAR. 2500.00 COMES OUT OF YOUR POCKET. THANKS TRUMP AND THANKS FOR TAKING AWAY THE WRITE OFF AWAY.
$2,500 isn't that bad believe it or not, there plans that are $4,000 or $5,000
PPO is better. HMOs are garbage