Employees of an organization receive some benefits from their employers. It includes health benefits or a group health plan. It provides medical care for the participants or their dependents directly or through reimbursement, insurance, or otherwise. In the case of health insurance, the employees have to choose between a health maintenance organization (HMO) and a preferred provider option (PPO). Here are a few benefits of HMO and PPO for those facing difficulty choosing an option.
Benefits of HMO plans
An HMO plan is an insurance structure that provides coverage through a network of physicians. Here, the primary care physician (PCP) will refer the patients to specialists when needed, but one must stay within the network of providers to receive coverage. However, HMOs are economical and have plenty of advantages, some of which are listed below.
Affordable premiums
HMO plans for employees and their dependents are likely to be more affordable than PPOs. On average, the cost of the premium is $663 for an employee and $1862 for a family. But the individual and his dependants must stay within the network to ensure low-cost coverage.
Lesser plans with deductibles
Among the employees covered by employer-provided health benefits, close to 43% of participants and 42% of families with HMO plans have no deductibles. HMO provides a comprehensive set of services as long as the doctor or hospital is part of the network. Patients seeking treatment outside the network may have to pay a higher deductible, excluding emergencies and a reciprocity arrangement.
Assured coordinated care
In HMO plans, the PCP helps to coordinate the care to be received by the patient. They manage the treatments themselves and, in some instances, might also refer the patients to specialists for optimum care. This advocacy and guidance provided by the PCP greatly help patients when they’re unwell and also help them seek doctors’ advice within the network.
No extra fees for care
Once the PCP refers the patient to a doctor in the network, all the payments are taken care of by the HMO provider. Also, no extra charges are involved; the patient may only have to handle the copay.
Benefits of PPO plans
PPO plans are immensely popular employee health benefit plans. These are designed for both individuals and families. Even though these plans also involve a network of doctors and specialists, one can also opt for healthcare professionals outside the network and receive coverage. Some of the benefits of PPO plans are listed below.
Increased flexibility
Unlike HMOs, one does not have to visit a PCP and seek a specialist’s advice. Furthermore, PPO plans also pay partial costs for care received from healthcare professionals outside the network. This makes it easier for the patient to choose from a wide variety of doctors and specialists according to their needs.
No referrals
In the case of PPOs, PCPs are optional. It means that no doctor manages and coordinates the overall care received by the patient. So, patients can choose the doctor they want and not seek a referral for the consultation and treatment of their conditions.
Wide range of services
A few PPOs offer a more comprehensive range of services. So the employees looking for health benefits can look beyond traditional checkups and preventive care. Some of the services included in these plans are acupuncture and chiropractic.
Available anywhere
As the patient does not have to limit themselves to a network of doctors and specialists, PPO plans can be availed anywhere out of the home state. So this provides more flexibility to patients as they can avail of these plans and their services even while traveling.
Freedom of choice
PPOs offer a more extensive network of doctors compared to HMOs. It gives one more control over their own choices. Furthermore, if their schedule includes a lot of travel, it gives them the freedom to choose and visit the doctor of their choice and receive treatment under them.
Employee health benefit plans may vary depending on the coverage. Hence, it is imperative to analyze one’s needs and preferences before choosing a particular plan. Further attention should also be given to the premium amount, services involved, and flexibility to make an informed decision about the health benefits provided by the employer.
