Health Insurance Agency in Kerman, CA
NOLIMITS Insurance Services
HMO Health Insurance Plans
What is a Health Maintenance Organization (HMO) Insurance
Health Maintenance Organization (HMO) Insurance plans usually limit coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. These kinds of plans may require you to live within the Kerman, CA area to be eligible for coverage.
An HMO gives you access to certain doctors and hospitals in California within its network. A network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. But unlike PPO plans, care under an HMO plan is covered only if you see a provider within that HMO’s network. There are few opportunities to see a non-network provider. There are also typically more restrictions for coverage than other plans, such as allowing only a certain number of visits, tests or treatments.
Some other key points about HMOs:
Some health insurance plans for Kerman, CA residents may require you to select a primary care physician (PCP), who will determine what treatment you need. With some plans, you may need a PCP referral to be covered when you see a specialist or have a special test done. If you opt to see a doctor outside of an HMO network, there is no coverage, meaning you will have to pay the entire cost of medical services.
Premiums are generally lower for HMO plans, and there is usually no deductible or a low one. Some HMO plans, including those offered by Medical Mutual, do not require you to select a PCP or have a referral to see a specialist.
HMOs often prioritize preventive care and wellness programs. This means you may have access to a range of screenings, vaccinations, and other preventive services in Kerman, CA at little or no cost.
In HMOs, there's often better coordination of care among different healthcare providers, which can lead to more integrated and comprehensive treatment.
If you frequently travel or spend significant time away from Kerman, California, an HMO might not be the best choice, as coverage may be limited outside of the plan's service area.
PPO Health Insurance Plans in Kerman, CA
What is a Preferred Provider Organization (PPO) Insurance
A Preferred Provider Organization (PPO) is a type of health insurance plan that offers a network of healthcare providers, including doctors, hospitals, and specialists, that have contracted with the insurance company to provide services at a discounted rate to plan members.
Our PPO insurance plans in Kerman, CA provide more flexibility when picking a doctor or hospital. They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate.
Here are some key features:
You can see the doctor or specialist you would like without having to see a PCP first. You can see a doctor in Kerman, CA or go to a hospital outside the network and you may be covered. However, your benefits will be better if you stay in the PPO network. Premiums tend to be higher, and it is common for there to be a deductible.
Primary Care Physicians
Most HMOs will require you to select a primary care physician in Kerman, CA, who will be the primary point of contact for your medical care. Your PCP will determine what treatments you need, and will refer you to specialists if he or she determines specialized care is medically necessary. Costs for specialists will not be covered without a PCP referral. In contrast, PPOs tend not to require selection of a PCP, and you can usually see a specialist without a referral, and still have these costs covered.
Costs
The additional coverage and flexibility you get from a PPO means that PPO plans will generally cost more than HMO plans. When we think about health plan costs in Kerman, CA, we usually think about monthly premiums – HMO premiums will typically be lower than PPO premiums. Another cost to consider is a deductible. This is the amount of health care costs you must pay before your plan begins to cover your costs. Not all HMOs have deductibles, but when they do, they tend to be lower than PPO deductibles.
Call NOLIMITS Insurance Services now to learn more about our health insurance coverage plans in Kerman, CA.