The Walker Winslow Financial Group, LLC works with over 15 health insurance companies. We provide these alternatives to help you find the right coverage for you or your family. One-stop shopping for coverage and affordability.
What is an HMO?
An HMO is a Health Maintenance Organization. Unlike traditional health insurance, an HMO sets out guidelines under which doctors can operate. On average, an HMO costs less than comparable traditional health insurance, with a trade-off of limitations on the range of treatments available.
The ways in which an HMO is able to offer cheaper insurance are twofold. First, by contracting with specific providers of health care and dealing with large quantities of patients, the HMO is able to negotiate for more affordable health care than the patients would otherwise receive. Secondly, by eliminating treatments the HMO views as unnecessary, and by looking after the long-term health of their members, the HMO reduces costs.
When one joins an HMO, one is usually asked to choose a primary care physician. This doctor then acts in part as the HMO's agent in determining what treatments the patient does and does not need. When the primary care physician determines that the patient needs care they cannot offer, they give a referral to a specialist that can address the patient's concerns. Emergency visits are exempt from this referral limitation, of course, and in many cases women are able to choose an OB/GYN as well.
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What is a PPO?
Preferred Provider Organization. A health care organization composed of preferred physicians & hospitals, or other providers which provides health care services at a reduced fee. A PPO is similar to an HMO, but care is paid for as it is received instead of in advance in the form of a scheduled fee.
PPOs may also offer more flexibility by allowing for visits to out-of-network professionals at a greater expense to the policy holder. Visits within the network require only the payment of a co-pay. There is often a deductible for out-of-network expenses and a higher co-payment. A policy holder will have a primary physician within the network who will handle referrals to specialists that will be covered by the PPO.
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