If you have a doctor or group of doctors you have been seeing or would like to see, be sure they are in the health plan's network. Always be sure to verify if with the insurance plan your doctor is in network.
Because health plan and network information may change, we recommend confirming your choice is available in your area by contacting the health plan's customer service number listed on their website.
Types of plans:
HMO - Health Maintenance Organization (HMO)
Generally with an HMO plan you must choose a Primary Care Physician (PCP) from a network of local healthcare providers. Most of your healthcare will be coordinated through your PCP. If you need a referral you will first need to contact your doctor to have them refer you to an in-network specialist. Your out-of-pocket cost and monthly premiums generally are lower with this type of plan.
PPO - Preferred Provider Organization (PPO)
Generally with a PPO plan you are allowed more flexibility and choices when it comes to your healthcare. Usually you are given a network of healthcare providers to choose from which allows you to choose an in- or out-of-network doctor, specialist or hospital. In most cases a referral is not needed. Your out-of-pocket costs are greater generally if you see an out-of-network-doctor. Also, your monthly premium will tend to be higher.