If you have a Blue Cross Blue Shield (BCBS), it’s important to understand the difference between the Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO). Let’s take a closer look at how these plans work so you can choose the ideal option for your unique situation.

What is an HMO and a PPO?

With an HMO, you’ll receive access to doctors and hospitals within its network. Put simply, a network contains set providers that will perform services for lower rates and meet certain quality standards. HMO plans differ from PPO plans because they only cover you if you see in-network providers.

Therefore, if you’d like to see out-of-network providers, it probably isn’t the best fit. You’ll also find that HMO plans come with restrictions and limit the amount of visits, tests, or treatments you receive. Depending on your HMO plan, you may need to select a primary care physician (PCP) who will refer you every time you require the care of a specialist. When it comes to premiums, they’re usually lower for HMO plans and there’s a low deductible or no deductible at all.

PPO plans are generally more flexible than HMO plans. While they also have a network of providers, you may still see non-network providers if you’d like. Even if you opt for care from a non-network provider, your insurance plan may still pay for at least some of it. Also, you’ll be able to see a specialist without getting a referral from a PCP. Compared to HMO plans, PPO plans feature higher premiums with deductibles.

Which Does BCBS Offer?

Blue Cross Blue Shield (BCBS) offers both HMO or PPO plans. This is great news as there are pros and cons of both options. While an HMO may be right for you, for example, someone else might be better off with a PPO.

What to Consider When Choosing HMO or PPO

Before you move forward with an HMO or PPO, think about your healthcare needs, budget, and preferences. If you’d like lower premiums and don’t mind seeing in-network providers, an HMO plan is likely your best bet. You should check the HMO providers that a potential plan covers to ensure they work for you. There may be a lack of HMO providers near you, making your decision easier.

If you prefer more flexibility and want coverage every time you see an out-of-network provider, a PPO makes sense, especially if you don’t mind paying more for your insurance plan. If you have a chronic condition or tend to see a lot of specialists, the extra cost of a PPO may be well worth it. In fact, it may save you thousands or even tens of thousands of dollars.

Contact MAIR Agency Today

If you’re interested in learning more about HMO and PPO plans or would like to find the right health insurance plan for your unique situation, don’t hesitate to contact us today. We’d be happy to answer any questions you may have and guide you through the process.

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Just awarded the #1 Medicare Agency by Blue Cross NC

We were contracted by Blue Cross NC in 1996 and quickly became an Exclusive Presidents Club Agency for them, maintaining this top producing agency level year after year. We are honored to receive the #1 Medicare Agency in North Carolina for two years in a row.

This award and acknowledgment requires much more than selling a product. This recognition requires our agency to exhibit unsurpassed customer service as well as provide advisors/agents that are consistently the most informed, educated and best support-arm for you, our clients.

We thank our existing clients for having the faith and trust in us that brought us to this achievement. For those of you approaching the need to now benefit from the Medicare you supported for many years with your tax dollars, and maybe some of you that wonder if you have made the best choices in the past, we welcome you to give The Mair Agency an opportunity to meet you. We will ensure you have complete knowledge of all your options and perhaps become a family member of the #1 agency in North Carolina with BlueCross and BlueShield.