Pennsylvania is the home to dozens of of the best PPO and HMO health insurance plans available to consumers. Not only do you receive lower rates, but the network of providers allows you to freely choose who handles your medical treatment and where you go to receive those services. And actually, there are very few Pa plans that don’t utilize this type of coverage. Managed care plans are designed to offer lower premiums and we can review the best options with you.
All of the new State Exchange plans utilize a provider network that gives you access to the finest doctors and hospitals in your area. Whether its UPMC or Highmark in Western Pa or Geisinger or Keystone in other parts of the state, the Pennsylvania Marketplace will allow you to choose among several options. If you need help understanding Obamacare in Pa, we wrote a separate article about it that should be helpful.
Our authoritative website explains in detail some of the differences between the two types of benefits. Which one is best for you? That depends on many factors including the type of medical expenses you typically incur in a year along with the availability of plans in your area. For example, most parts of Pennsylvania have several PPO plans to choose from. But the number of available HMO plans is growing, while PPO availability is decreasing.
The ACA Legislation And Its Effect
Obamacare, although passed in 2010, continues each year to cause reductions in the number of available policies, physicians, specialists, and other medical facilities. Not only are several companies no longer offering On-Marketplace plans, but HMOs are replacing PPOs in record numbers. There are approximately 40% less preferred-provider networks offered to Pa residents compared to pre-Obamacare years.
Thus, Keystone State residents often face out-of-network restrictions that can severely limit choices. Since most Exchange plans are subsidized, lower-income households often have fewer choices, especially if they seek out-of-the-area treatment. For example, the total number of PPO plans available countrywide is about 500 less than prior years, while there are more than 100 new HMO options offered.
HMO AND PPO Differences
With an HMO, you select a single doctor to coordinate all of your healthcare needs and treatment. For example, if you suddenly notice that your knee is swollen and hurts when you walk, a visit to your primary care physician (pcp) is required. They will subsequently refer you to a specialist that will treat that specific condition.
Conversely, with a PPO, assuming that same scenario, you can simply directly contact an orthopedic specialist for a consultation and possible treatment. You do not need a referral and you determine which type of treatment (or no treatment) that you receive. Flexibility of choosing who treats you and when you visit, are key features.
With many companies, your “network” extends countrywide and is much more extensive than an HMO. For example, Aetna offers the opportunity to utilize more doctors and facilities in nearby states (Ohio, New Jersey, New York, Delaware, and Maryland) along with the rest of the US. Conversely, Geisinger plans will be much more restrictive.
Impact Of Pre-Existing Conditions
Your existing medical conditions (if you have any) play a vital role in your decision. If you are treated by multiple specialists, it may be critical to ensure that all of them remain in the local provider network. With Open Enrollments occurring every November, it’s possible that you may have to change carriers or face the possibility that one (or more) of your physicians will no longer be available.
Comparing and reviewing new plans each year is highly encouraged. But equally important is to ensure your existing specialists (and physicians) are not dropping out of your carrier “approved provider” list. If your illness or disease requires multiple visits (especially pain management), changing providers can be challenging, especially if few options are available in your area that accept new patients.
If you live on the Western part of the state, UPC and Highmark have large coverage areas and offer extremely competitive rates. Highmark, Capital Blue Cross and Geisinger are reliable carriers to consider if you live in Central Pa. And towards Philadelphia, Keystone (Independence Blue Cross) offers both HMO and PPO plans that are often priced lower than all competitors. Both high-deductible and comprehensive policies are easily purchased. Aetna also offers attractively-priced plans in most of the state.
UnitedHealthcare and Aetna have statewide coverage for their provider network and should be considered in all areas. Aetna is also a national carrier and is in the process of merging with CIGNA.
We’ll teach you the differences in Pa HMO plans and PPO plans. Both are comprehensive medical policies that are offered through the best insurers. You can view the best rates online from our website, and save money by utilizing our help.