What is the Difference Between HMO, EPO and PPO, Medicare, Marketplace, and More
ฝัง
- เผยแพร่เมื่อ 3 มิ.ย. 2024
- What is the Difference Between HMO, EPO and PPO, Medicare, Marketplace, and More
Call us at iHealthBrokers today at 888-410-0344. Our services are 100% Free!
★☆★ABOUT THIS VIDEO★☆★
0:00 Intro
0:33 PPO
3:21 Dental Insurance
5:05 Short Term Medical
6:26 Medicare Advantage
7:07 EPO
9:11 HMO
10:30 Final Thoughts
PPOs will give you the most flexibility. You will not need a PCP which is primary care physician. You will also not need a referral to see a specialist. So, what does that mean? Basically, if you want to see anyone other than a general practitioner, with other types of plans you need to first go to your PCP to have them refer you to a specialist like a cardiologist or neurologist. This can be difficult for many reasons.
It’s an extra visit
You have less control
Waiting
Now these types of plans usually have higher monthly premiums when compared with HMOs or PPOs. However you will have coverage in and out of network. This applies to marketplace plans, private insurance, short term medical plans, Medicare Advantage (more on that in just a moment) and even dental insurance.
While we are discussing dental insurance, we would recommend going the PPO route. When discussing general health insurance, it is often not too difficult to find a PCP who is in network. This is often not the case with dentists. It can be very difficult to find a dentist who accepts a DHMO. Also, because of the way DHMO dentists bill, many patients report dissatisfaction and feeling rushed.
If you definitely want a PPO and you are under 65, they can be very difficult to find the on marketplace. Of course, there are a few exceptions, but they are few and far between. If you are intent on a marketplace plan and need more flexibility, then EPOs are your best option.
If you really need a PPO then private insurance will be easier to find. However, private insurance can be rather pricey. So, you may want to look into a short term medical plan.
Short term medical plans can be a great way for a younger mostly healthy person to have a large range of benefits at a lower price. So the pros are:
Lower premium
Year round enrollment
Nationwide PPO coverage
Customizable
However, short term medical plans are not ideal for all people and they are not even available in all states. They will not cover pregnancy and although some preexisitng conditions will be covered after the first year of a multi-year plan, if you have a more complex condition, it may not be covered at all. These types of plans are also not ideal for people with young children.
PPOs may be available for Medicare Advantage plans as well. Medicare Advantage is a replacement for Original Medicare. A Medicare Advantage plan (even a PPO) will STILL not offer you the same freedom as Original Medicare with a Supplement, but they can be an alternative if you are looking for a broader range of benefits with a lower monthly premium. Most of our clients still opt for a Medigap plan, with good reason, and they are far more popular than Medicare Advantage Plans.
Then there are EPOs. EPOs sort of split the difference between a PPO and HMO. They are much more common on the marketplace. Usually you will still need to stay in network (except in a medical emergency) however you will likely not need a PCP or referrals for specialists. Additionally, they are readily available on the marketplace.
Finally, there are HMOs. HMOs are usually your least expensive option. However, you must operate within network. If you choose to go out of network, you will NOT be covered.
The exception to this is in a true medical emergency. If you need immediate and urgent medical care at a hospital, under the ACA you cannot be charged more for the ER at an out of network facility vs. in network. Balance billing is a thing of the past.
With HMOs you will also need a PCP. You will also need a referral to see a specialist. Often if you have insurance through your employer, you will have an HMO and PPO option. HMOs are also plentiful on the marketplace and of course, if you choose Medicare Advantage there are many HMOs to choose from.
If you have any further questions, please feel free to contact us here at iHealthBrokers at 888-410-0344 or ihealthbrokers.com/
👇SUBSCRIBE TO iHealthBroker's CHANNEL NOW👇
th-cam.com/channels/5jc.html...
★☆★CHECK OUT OUR OTHER VIDEOS★☆★
How to Save Money on Health Insurance
• Save MONEY on HEALTH I...
Short Term Medical Insurance
• BEST KEPT SECRET IN HE...
Healthcare Ministries
• Healthcare Ministries ...
Direct Primary Care
• What is Direct Primary...
Parts of Medicare
• Parts of Medicare Part 2
===================================
★☆★CHECK US OUT ★☆★
WEBSITE: ihealthbrokers.com/
PHONE NUMBER: (888) 410-0344
F A C E B O O K: / ihealthbrokers
===================================
Give us a call or leave a comment below and we'll do our best to help! Make sure to "Like" and "Subscribe" today!
I sense PPO is better despite being higher monthly costs but is better and more convenient. For example, imagine having to wait weeks for your PCP to get referral for a specialist. However, if it's urgent and you can't get to the PCP in time, might as well go to the ER and spend lot more money. In addition, you were have to pay two copays going to your PCP and specialist. This is why I prefer the PPO plan
We absolutely agree!
Hi can you pls explain
Medicare HMO PPO vs Advantage HMO PPO.
Medicare Advantage offers HMOs and PPOs. Original Medicare does not as there are no networks. So, the same differences highlighted in the video apply. Basically, PPO: higher premiums, in and out of network coverage, no PCP, no referrals. HMO: lower premiums, only IN NETWORK coverage, PCP and referrals required.
i soon have to get on enroll Medicare.. turning 65.. but see Part A is free i guess.. worked 40 yrs..
but Part B is huge $164.90/mo Can't afford that no way No job. No income. $0 inc. No way !!
in MA Can I get Adv plan or MediGap or sthing.. idunno
to help pay ..tax credit ? to pay Part B and or Part D too.
(is that Part C then kinda?)
so stupid confusing.
MC rly rly rly Suckkks charging Everybody $164.90 + higher for US govmint bs insurance.
What a Ripppoff.. and get very little for it to boot huge huge deductibles.. copays etcetcetc.
What a load crap. smfffh
can't bevlieve it
Hi Phill. I saw your other comment as well. Definitely look into DSNPs and Medicare Savings Programs. We have videos here: th-cam.com/video/h5F9Hxj-vwk/w-d-xo.html and here: th-cam.com/video/MQL7p-g3u7I/w-d-xo.html Feel free to call us with any questions! 888-410-344
May be too late to address your issues, but for others, see a Health Insurance Broker. They can help you decide and sign you up for any of the programs available in your area. Takes away your stress and there's no fee to you. Whichever insurance company they sign you up for pays them a fee. 9 out of 10 people that sign up on the Marketplace do so when they qualify for assistance with the payment. For those who have a larger income (I think it's over $20K per year for an individual for single coverage) you don't need to go to the Marketplace to sign up. You can go directly to a company or it's better to go to a Broker, which compares network types and companies for your needs and signs you up without a fee. My son is aging out due to turning 26 and a broker was so very helpful.