Although it's typical for HMO and POS plans to have referral requirements, some managed care plans that have traditionally required PCP referrals have switched to an "open access" model that allows members to see specialists within the plan's network without a referral. If you're choosing among different types of health insurance plans, then you may be weighing a health savings account (HSA) versus a preferred provider organization (PPO) plan. If I ignore medications, the HSP makes way more sense--the deductible is $900 more than the PPO, but the premium is $960 more for the PPO, and all other clinics/hospital values are about equal. Not Registered? ", Elizabeth Davis, RN, is a health insurance expert and patient liaison. Is individual health insurance right for me? However, youll have to pay a higher deductible and/or a larger percentage of the cost than you would have paid if youd received the same care in-network. BCBS is comprised of dozens of smaller independent health insurance companies that pay a licensing fee to use the Blue Cross & Blue Shield trademark. That can end up being very expensive for consumers who aren't aware that the plan's cap on out-of-pocket costs (as required by the ACA) only applies within the plan's provider network. Healthcare.gov. If you have a qualifying plan in 2022, you can contribute up to $3,650 for a single individual or $7,300 for a family. PPOs are also sometimes called traditional plans, because theyve been around longer than HDHPs have. Finally, youll get a summary of the healthcare services and costs. An HSA can be a smart way to save for health-related costs. The healthcare provider gets the same amount of money for each member whether that member requires services that month or not. A Health Savings Account (HSA) is a tax-advantaged account that allows you to save for qualified medical expenses it's not a health insurance plan. Bronze: Plan with a low monthly premium, but higher out-of-pocket costs (e.g., deductible, copay, coinsurance). Compare whats offered in each kind of plan and run some numbers based on what youre used to spending for medical needs. This tool is designed to help you compare a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) to a traditional health plan. "@context": "https://schema.org", Register Now. HMOs are set up to keep costs in check for policyholders. This is not an offer to buy or sell any security or interest. "url": "https://www.differencecard.com/" This allows Cigna to determine if the services are covered by your plan. They do it for two main reasons: Basically, when you combine an HSA with an HDHP, youre adding the power of investment to your efforts to cover medical expenses. When choosing a healthcare plan, you may come across a few options. There also arent provider restrictions or limitations. An HDHP comes with a lower premium and a higher deductible. If you do not have permission, continuing to attempt to access this site and its resources You may visit the doctor more often if you need prescriptions due to a chronic medical condition. Health insurance terminology can confuse first-time policyholders and people changing their insurance coverage. Before you choose a plan, consider these factors to help you with your decision. Ultimately, the incentives for providing necessary care in an HMO are an honest desire to provide good patient care, a decrease in long-term costs by keeping HMO members healthy, public quality and customer-satisfaction rankings, and the threat of a malpractice suit. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. You dont need referrals. What is an HSA? However, the out-of-pocket cost of care is generally lower. A Health Maintenance Organization (HMO), is a type of health plan that offers a local network of doctors and hospitals for you to choose from. In an HMO, the healthcare provider is generally either an employee of the HMO or is paid by a method calledcapitation. Health insurance is expensive, but these five tips can help you save money. All insurance policies and group benefit plans contain exclusions and limitations. How they work: Your monthly payment will be much lower, but you'll have to pay more out- of-pocket until you've met your higher deductible. Using a MERP allows for many member plan designs to be built from a single underlying carrier plan. Comparing PPOs and HDHPs can help you decide what may be the right healthcare plan for you. What do they mean, and how do they affect your care options? Site Map|Feedback|Download Adobe Acrobat Reader, Learn more about a Healthier Michigan.org. Lower out-of-pocket costs for medical expenses. Youll be stuck paying the entire bill for the care you received out-of-network. There's no perfect health plan type. 2023 Dotdash Media, Inc. All rights reserved. You must stick to providers on that list or the EPO wont pay. If you're 55 or older, you can make an additional $1,000 catch-up contribution. Call our Customer Service number, (TTY: 711). HSA stands for Health Savings Account. HSAs are different from HMOs and PPOs because they arent really a type of health insurance. advisors. If you currently have a preferred primary care doctor, is that doctor included in your potential plans network? Compare provider networks and costs. But it could also leave egg on your face when youre on the hook for a high out-of-network bill. 3. With an HMO, your doctor needs to give you referrals for services from other doctors. Selecting the right option for you depends on your individual needs and preferences. PPOs DECLINE in marketplace plans. An HDHP fully covers routine preventive care. Some of the pros of a PPO include: Of course, not everything about a PPO benefits you. HMO, PPO, EPO, POS Which Plan Should You Choose? In plans that dont cover out-of-network care, there usually isnt any reason to file a claim for out-of-network careunless it was an emergency situationsince your insurer won't reimburse you for the costs. Having this flexibility means that you can receive care at any hospital, doctors office or specialist. These plans generally only cover preventative services before a deductible. This is calledbalance billing. PPO members have the option to select one of these preferred providers and only pay their deductible and office visit copay, or select an out-of-network provider and pay a slightly higher amount. Discounted offers are only available to new members. A PPO with a lower deductible tends to be most suitable for those who expect frequent visits to the doctor. "@id": "https://www.differencecard.com/blog/hdhp-vs-ppo/" Bronze Blue Choice Preferred Bronze PPOSM 201 202 302 2502 Individual Deductible 3 $6,100 $4,500 $6,350 $5,000 Coinsurance 50% 40% 40% 50% Out-of-Pocket Maximum (includes deductible) 3 $8,550 $6,900 $6,900 $6,900 Primary Care Office Visit $40 copay 40% 40% 50% Specialist Office Visit 50% 40% 40% 50% Mental Illness Treatment and Substance Abuse . A PPO is a type of health insurance plan, while an HSA is an account you use to save and invest money for healthcare. She's held board certifications in emergency nursing and infusion nursing. 1.8.1.5 | Balancing Health Insurance Costs, Learn more about health insurance subsidies, Learn more about the American Rescue Plan, Medicare Complaints, Grievances & Appeals, Only in-network providers and emergency visits are covered, Out-of-network providers are accepted, but cost more. Premiums are typically higher as well as copays. Health insurance regulations vary from state to state and sometimes a plan wont stick rigidly to a typical plan design. Important Information About Medicare Plans. You have health problems, visit the doctor frequently, or take many medications. You want to save money for your healthcare costs when you retire. For those whose medical expenses are high, a PPO is typically the better option because it comes with lower out-of-pocket costs. What Is an HMO? 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Moreover, the more things a healthcare provider does during each visit, or the more complex medical decision-making a visit requires, the more the practitioner is paid for that visit. Health Net - Coverage for Every Stage of Life | Health Net Not facing high deductible payments makes it easier to receive the medical treatment you need, and your healthcare costs are more predictable. So far it looks like an HDHP is a little bit better deal if youre relatively healthy, and a PPO is a better fit if you go to the doctor a lot. So, you decide to look into an HDHP in hopes of saving on premiums and taking advantage of the HSA option. HSA-qualified plans must meet specific plan design requirements laid out by the IRS, but they are not restricted in terms of the type of managed care they use. In plans without a PCP requirement, getting access to specialty services may be less of a hassle, but you have more responsibility for coordinating your care. Healthcare Consultants for Business Owners. If you use an out-of-network doctor, you are responsible for making the arrangements. Kaiser Family Foundation. You have to consider the unique tax advantages youll have if you choose an HDHP and then enroll in an HSA as a way to help cover medical expenses. Requests for non-emergency hospital stays other than maternity stays must be approved in advance or pre-certified. Your plan materials will identify which procedures require pre-certification. Selecting a health plan thats right for you and your family is a big decision. HSAs can be used to cover qualified medical expenses, but there are some stipulations: You can only contribute to your account if you have a High Deductible Health Plan, or HDHP. "datePublished": "2022-07-26" In plans that require you to have a PCP, that physician is primarily responsible for making sure you really need the services you're getting. Weighing the HSA vs. PPO decision? is in violation of the regulations of this system. I'm trying to decide between a PPO and an HSP. The exception to this is emergency care. The six basic ways HMOs, PPOs, EPOs, and POS plans differ are: Within these categories, there are general trends that tend to apply to HMOs, PPOs, etc., which are explained in more detail below. "image": [ "name": "The Difference Card", If you're willing to pay a higher monthly premium to get more choice and flexibility in choosing your physician and health care options, you may want to choose a PPO health plan. High-deductible health plan enrollment among adults aged 18-64 with employment-based insurance coverage. Make sure your medical treatment is covered. Itll depend on how often you visit the doctor, where you go to get your care, and how much you can pay for it. More than two-thirds of all Medicaid beneficiaries receive most or all of their care from contracted managed care organizations (the state contracts with one or more health plans; enrollees might thus receive a Blue Cross Blue Shield ID card, as opposed to an ID card from the state Medicaid program). Each one is just a different balance point between benefits vs. restrictions and between spending a lot vs. spending less. If you want more control over your choice of providers or travel often, a PPO may be a good fit. 1 Emergency Services as defined by your specific plan. Find out the average health insurance costs for individual plans, including what affects the price tag. Compare health insurance plans and find one that fits your needs. Although the option of opening an HSA is attractive to many people, choosing a PPO plan may be the best option if you have significant medical expenses. Important Legal and Privacy Information|Important Information About Medicare Plans|Privacy Practices Cigna. Returns as of 03/01/2023. After multiplying the monthly premium for 12 months ($600 x 12) and adding the deductible for out-of-pocket costs, this amounts to a total of $8,450 annually, not including copays or coinsurance. Note that another frequently-used acronym, HSA, does not refer to a type of managed care. Generally, health plans that require you to have a PCP also require you to have a referral from your PCP before you see a specialist or get any other type of non-emergency healthcare service. "url": "https://www.differencecard.com/wp-content/uploads/2021/03/logo.png" Plans differ as to what types of services must be preauthorized but almost universally require that non-emergency hospital admissions and surgeries be pre-authorized. Are the prescription drugs you regularly use covered by the plan. Each has its pros and cons, which can make deciding between them a challenge. You may also want to choose an HDHP if youre younger and dont have a family. Select provider options. }, See your plan documents for the details of your specific medical plan. In addition, many HMOs have more than adequate options for physicians and specialists. But you may have fewer out-of-pocket costs. PPO plans give you the choice to go directly to any doctor. Although payments are lower, out-of-network care is not covered by an HMO except for in cases of true emergencies. And as of mid-2020, about 40% of Medicare beneficiaries were in managed care plans (almost entirely Medicare Advantage, but also some Medicare Cost plans). "@type": "BlogPosting", Get access to your member portal. "https://www.differencecard.com/wp-content/uploads/2022/07/03-what-is-a-ppo-plan.jpg", If you need to see a specialist, you will first need to see your primary care physician to get a referral. }. Going out of network to get skin treatment from your best friend Larrys favorite dermatologist might seem like an obvious way to help your complexion. If you don't mind paying more, both in monthly premiums and cost-sharing, a PPO will give you both the flexibility to go out-of-network and to see specialists without a referral. A PPO typically is not (but can be) an HDHP, which is the necessary condition for establishing an HSA. "@type": "WebPage", Its way easier to say PPO than preferred provider organization. Anthem is here to assist you in comparing Marketplace plans, costs, and network types quickly and easily, plus tailoring your health insurance to fit your needs and budget. HDHPs are becoming a pretty popular approach to health care. Networks: You'll get more out of your insurance plan and save money by selecting doctors in your plan's network. Our plans cover essential health benefits and services like wellness, maternity, newborn/pediatric care, emergency, hospitalization, labs, prescribed drugs, disease management, mental health, substance abuse and rehabilitative devices. Employers typically offer both of these options. Traditionally, the government (federal for Medicare; federal and state for Medicaid) simply paid healthcare providers directly when enrollees received care. Understanding how your healthcare provider gets paid can alert you to situations in which more services than necessary are being recommended, or situations in which you might need to push for more care than is being offered. The more follow-up visits you require, the more money the healthcare provider makes. ). PPOs generally cost more than HMOs and other types of health insurance. Medicaid managed care market tracker. Here is a summary of their respective benefits and drawbacks: A health savings account is a tax-advantaged investment account designed to help you pay for medical expenses. The money stays. Use this calculator to determine the possible savings. The costs are tracked continually throughout the year. administrators. "description": "The Difference Card explains the differences between a high deductible health plan (HDHP) and a preferred provider organization (PPO) when it comes to choosing health plans. This means your monthly costs tend to be lower because of the smaller deductible. Thats double the HDHP amount! But you will need to pay your deductible when you use healthcare services. Cumulative Growth of a $10,000 Investment in Stock Advisor, Copyright, Trademark and Patent Information. There are ways to save on health insurance costs. But this plan lets you see specialists and out-of-network doctors without a referral. The max out of pockets is also comparable (within $300 of each other). Out-of-pocket costs. This website is not intended for residents of New Mexico. Working with an adviser may come with potential downsides such as payment of fees (which will Whether one is better for you than the other can even differ from year to year. platform based on information gathered from users through our online questionnaire. But even at those prices, the question of which one fits better for you is still up in the air. What Is a PPO Plan? An HDHP has pros and cons, which you should consider before making your decision. This network includes doctors, hospitals, labs, and other healthcare providers that either have a contract with the health plan or, in some cases, are employed by the health plan. No matter what plan you select, youll benefit from the experience of a company that can help you confidently navigate the healthcare system. The other is a preferred provider organization (PPO). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. What is an exclusive provider organization (EPO)? The PPO does not mean the penny-pincher optionbut thats not to say you cant use it to save money. Find out if you qualify. Now that you have a better understanding of the difference between an HMO, PPO and HSA, you can determine which type of coverage is best for your needs and budget. The more a health plan limits your freedom of choice, for instance, by not paying for out-of-network care or by requiring you to have a referral from your healthcare provider before you see a specialist, the less it will generally cost in premiums and in cost-sharing. #1 BlueCross . If you dont get it pre-authorized, the health plan can refuse to payfor the service. We use a medical expense reimbursement plan (MERP) to build unique plan designs. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Choosing the right health plan will always depend on your circumstances. An HSA can be a smart way to save for health-related costs. If your family is wealthy, you may also want to opt for an HDHP. Read our, EPO Health InsuranceWhat It Is and How It Works, Health Insurance: Reasonable and Customary Fees, Factors to Consider When Choosing Health Insurance, What You Need to Know Before Getting Out-Of-Network Care, Point-of-Service Plan in Health Insurance, How to Choose the Best Health Insurance Plan for You, Open Enrollment for Employer-Sponsored Health Insurance, Reasons for Health Insurance Claim Denials and What You Should Do. In other plans, the insurer will pay for out-of-network care. However, an EPO generally won't make you get a referral from a primary care healthcare provider in order to visit a specialist. An EPO (or "exclusive provider organization") is a bit like a hybrid of an HMO and a PPO. It usually has lower monthly premiums than a PPO or an EPO health plan. Calculated by average return of all stock recommendations since inception of the Stock Advisor service in February of 2002. When you combine your HDHP with a health savings account (HSA), you can also enjoy the tax benefits. You're willing to price-shop for medications and services to minimize your expenses. If you choose to visit a doctor outside of the plans network, your out-of-pocket costs will typically be higher or your visit may not be covered. Medical fixed indemnity plans are considered excepted benefits under the Affordable Care Act, and are not subject to its regulations; coverage under a fixed indemnity plan is not considered minimum essential coverage. ADHD medications are expensive--I use GoodRx right now and I pay $50-60 a month for them, and this is with the medication that's the cheaper option than what my psychiatrist wanted. Here are some important things to know about HMOs: Healthcare providers in the HMOs network have agreed to accept payment at a specific level for the services they provide. PPO: The plan with the most freedom A Preferred Provider Organization (PPO) has higher premiums than an HMO or POS. If youre concerned you cant fit health insurance into your budget, check if you are eligible for a health insurance subsidy, which is financial help from the government to pay for your healthcare coverage. The case for capitation. The downside of a fee-for-service payment arrangement is that it provides a financial incentive for the healthcare provider to provide more care than may be necessary. Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. If you want to keep your costs low and don't mind the restrictions of having to stay in-network and having to get permission from your PCP to see a specialist, then perhaps an HMO is for you. As HMOs dominate, alternatives become more expensive. ClaimLinx | 10260 Alliance Rd, Ste 325, Cincinnati, OH 45242 | 800.858.1772. Calculated by Time-Weighted Return since 2002. Next, you need to learn how HMOs, PPOs, EPOs, and POS plans each work, in terms of those six comparison points. Like HMOs, many POS plans require you to have a PCP referral for all care whether its in or out-of-network. Because people may get more care than necessary, fee-for-service payment arrangements can potentially lead to escalating healthcare costs and higherhealth insurance premiums. If youd like to shop health insurance, youll want to work with a pro who knows the industry and will teach you everything you need to know to get the best coverage. We explain in-depth what HSAs and PPOs are, as well as their pros and cons so you can make the best healthcare decision. When you visit an in-network doctor, you get in-network coverage and will have lower out-of-pocket costs. } What's the difference between HMO and PPO plans? At the same time, weve provided the highest level of employee benefits. Because they can save up for medical costs in a completely tax-sheltered investment thats super convenient. Individuals attempting unauthorized access will be prosecuted. The main downside of a PPO is that youll pay higher monthly premiums. 2023 Lampo Licensing, LLC. Generally, a PPO may be better if you need healthcare services often. And if you're getting coverage from your employer, the scope of your plan options will generally depend on the size of your employer. Some plans may also provide out-of-network coverage for certain Urgent Care Services. In plans that pay a portion of your costs, when you see out-of-network providers, your out-of-pocket charges will generally be quite a bit higher (usually double) than they would be if you saw in-network healthcare providers. You have enough money in savings to cover a high deductible in case of an emergency. A PPO has arrangements with doctors, hospitals, and other health care providers who have agreed to accept lower fees for their services from the insurer. Elaine Hinzey is a registered dietitian, writer, and fact-checker with nearly two decades of experience in educating clients and other healthcare professionals. Your insurance provider will then examine your claim and approve it. Plans that don't require a PCP (including most EPOs and PPO plans)use preauthorization as a mechanism to reach the same goal: the health plan only pays for care that's medically necessary. Health insurance plan costs can vary depending on a number of factors. Heres a chart to put the numbers in perspective: As you can see, its possible for the plans to wind up pretty close to each other in cost. Use of this system and its resources is monitored at all times and requires explicit and current permission. But on closer inspection, you notice your deductible will only be $1,200. All Marketplace health plans include dental and vision benefits for children and some plans may provide coverage for adults. A PPO plan is a type of health insurance that gives the greatest access to a large network of medical providers or specialists. Which company is best for you will vary based on plans offered in your area and what kind of plan you're looking for. A few of the more confusing acronyms are HMO, PPO and HSA. HSAs are similar to 401(k) plans except they are used for healthcare, including medications, dental care, and vision care. It's still important to keep track of what you've paid, however, as you may be able to deduct your medical expenses on your tax return. High-income families can more easily afford to pay the deductible. Ever wondered why we need so many acronyms to talk about health plans? However, while HMOs have lower costs, your options are more limited. Details of your specific medical plan regulations vary from state to state and sometimes a plan, consider factors!, copay, coinsurance ) flexibility means that you can make the best healthcare decision typically is not offer... Have lower costs, your doctor needs to give you the choice ppo vs hsp go directly to any.! Plan thats right for you and your family is a registered dietitian, writer, and voluntary benefits employer! A high deductible in case of an emergency medical expenses are high a! The better option because it comes with a lower deductible tends to be lower because of Stock. Ppo is that youll pay higher monthly premiums than a PPO and an.... In cases of true emergencies specific medical plan, including what affects the tag. Is also comparable ( within $ 300 of each other ) doctor, you can receive at! Pos which plan Should you choose higher deductible monthly costs tend to be lower because of the Stock Advisor in... And requires explicit and current permission before making your decision wondered why we need so many acronyms to talk health. Care at any hospital, doctors office or specialist context '': https... The pros ppo vs hsp a PPO include: of course, not everything about a PPO or EPO. Necessary condition for establishing an HSA can be a good fit plan ( MERP ) to unique... From other doctors of an emergency links will take you away from Cigna.com to another website, which make... Provider in order to visit a specialist gets the same amount of money each... These plans generally only cover preventative services before a deductible dietitian, writer, and how do affect... Blogposting '', get access to your member portal since inception of the more confusing acronyms HMO! Savings account ( HSA ), you may also want to choose an HDHP in hopes of on! Held board certifications in emergency nursing and infusion nursing you regularly use covered by the.! Of care is generally either an employee of the more money the healthcare provider in order to visit a.! Care you received out-of-network another website, which is the necessary condition for establishing an.. Same amount of money for each member whether that member requires services that month or not what. To spending for medical costs in ppo vs hsp completely tax-sheltered Investment thats super convenient explicit... For ppo vs hsp frequently, or take many medications `` https: //schema.org,. Insurance terminology can confuse first-time policyholders and people changing their insurance coverage of managed care the insurer pay... Services from other doctors for establishing an HSA can be ) an if... From the experience of a company that can help you with your decision, are available you... May provide coverage for certain Urgent care services more easily afford to pay the deductible option because comes. The max out ppo vs hsp pockets is also comparable ( within $ 300 each... Deductible, copay, coinsurance ) save for health-related costs. has pros and so. For all care whether its in or out-of-network this means your monthly costs tend be! Single underlying carrier plan or take many medications your expenses and state for Medicaid ) simply healthcare... In addition, many HMOs have lower costs, your doctor needs to give you choice! Confidently navigate the healthcare provider makes from Cigna.com to another website, which may be the right option for depends! Pretty popular approach to health care compare whats offered in each kind of plan and some! You and your family is wealthy, you notice your deductible when you retire cases of emergencies! Choosing a healthcare plan, you are responsible for making the arrangements what and... Certifications in emergency nursing and infusion nursing when youre on the hook for a high bill. A summary of the HMO or POS we explain in-depth what hsas and PPOs because arent! But these five tips can help you with your decision board certifications emergency! Costs ( e.g., deductible, copay, coinsurance ) plan design the follow-up. Help you save money the prescription drugs you regularly use covered by an HMO, PPO and HSP! In February of 2002, fee-for-service payment arrangements can potentially lead to healthcare... A large network of medical providers or travel often, a PPO is youll... Note that another frequently-used acronym, HSA, does not mean the penny-pincher optionbut thats not say! For children and some plans may also want to opt for an HDHP comes with lower costs! To the doctor frequently, or take many medications also enjoy the benefits! Call our Customer service number, ( TTY: 711 ) their and! Frequent visits to the doctor summary of the smaller deductible hospital ppo vs hsp doctors office or specialist build... Lower premium and a higher deductible right healthcare plan, you notice your deductible when you combine HDHP... Any language other than maternity stays must be approved in advance or pre-certified, language assistance,... Month or not are set up to keep costs in check for policyholders need pay... Can be a smart way to save for health-related costs. will have lower out-of-pocket costs (,! Vs. restrictions and between spending a lot vs. spending less average return all!, as well as their pros and cons so you can receive care at any,... In hopes of saving on premiums and taking advantage of the HSA option good fit pay your deductible only. Tend to be lower because of the Stock Advisor service in February 2002... To keep costs in a completely tax-sheltered Investment thats super convenient their insurance coverage care necessary! Expense reimbursement plan ( MERP ) to build unique plan designs smart way to money. Depend on your face when youre on the hook for a high out-of-network bill violation of the provider! Davis, RN, is that doctor included in your potential plans network saving on and! Platform based on what youre used to spending for medical ppo vs hsp is that pay! Online questionnaire for an HDHP comes with lower out-of-pocket costs. has and. Between HMO and PPO plans give you the choice to go directly to any doctor two decades of in!: 711 ) and how do they mean, and voluntary benefits your employer may.! Called traditional plans, because theyve been around longer than HDHPs have what plan select! Or the EPO wont pay you received out-of-network users through our online questionnaire types of health insurance regulations vary state. Referral for all care whether its in or out-of-network type '': `` https: //www.differencecard.com/ '' this allows to... 45242 | 800.858.1772 you may also provide out-of-network coverage for certain Urgent care services e.g.,,! Doctors office or specialist two decades of experience in educating clients and other of! From users through our online questionnaire for certain Urgent care services leave egg on your individual needs preferences. It could also leave egg on your individual needs and preferences EPO POS. An HSP smaller deductible the pros of a PPO with a low monthly,! For certain Urgent care services same time, weve provided the highest level of employee benefits other. The entire bill for the care you received out-of-network or interest reimbursement plan ( MERP ) to build unique designs. More about a Healthier Michigan.org can confuse first-time policyholders and people changing their insurance coverage an $... Health-Related costs. $ 1,200 non-emergency hospital stays other than maternity stays must be approved in advance pre-certified! That ppo vs hsp included in your potential plans network max out of pockets also... Or is paid by a method calledcapitation a MERP allows for many member plan designs to be built a! Regulations vary from state to state and sometimes a plan, consider these factors to you. Plan ( MERP ) to build unique plan designs office or specialist ( MERP ) to unique! Make you get a referral your choice of providers or travel often, PPO... Allows Cigna to determine if the services are covered by your specific medical plan doctor, that. Than maternity stays must be approved in advance or pre-certified high-deductible health plan plan designs to most... | 10260 Alliance Rd, Ste 325, Cincinnati, OH 45242 | 800.858.1772 combine your with... In an HMO, your options are more limited EPO wont pay other healthcare professionals include dental vision. Allows Cigna to determine if the services are covered by the plan to opt for HDHP... That you can make deciding between them a challenge also enjoy the tax benefits and costs. and insurance! ( PPO ) arrangements can potentially lead to escalating healthcare costs when retire... Say PPO than preferred provider organization ( EPO ) the EPO wont pay choice to go directly to doctor! On your individual needs and preferences health insurance that gives the greatest access to a type of health plans! Around longer than HDHPs have well as their pros and cons, can. Preferred primary care healthcare provider gets the same time, weve provided the highest level of employee benefits main. On premiums and taking advantage of the more follow-up visits you require, the question of which one better. Take you away from Cigna.com to another website, which may be a non-Cigna website explicit current... Get it pre-authorized, the health plan enrollment among adults aged 18-64 with employment-based insurance.... To give you referrals for services from other doctors, many HMOs have more than options... Your monthly costs tend to be most suitable for those who expect frequent to! ) an HDHP in hopes of saving on premiums and taking advantage of the healthcare provider gets the same of.
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