Ohio PPO and Ohio HMO

Get Ohio health insurance offers both HMO and PPO plans.PPO stands for one of three terms: Preferred Provider Organization, Preferred Provider Option, or Participating Provider Organization. All three phrases describe a network of healthcare providers who have entered into contracts with health insurance companies to provide healthcare at reduced prices in exchange for a steady volume of business. An Ohio PPO network usually consists of physicians, nurses, laboratory technicians, hospitals, clinics, laboratories, and other healthcare specialists and facilities. Most PPOs not only diagnose and treat illness and disease, but also provide preventive care, including well baby care, physicals, and screening tests such as mammograms.

With an Ohio PPO plan, you are able to reduce medical expenses by obtaining health care from medical professionals within your network. However, should you obtain services outside of your network your health insurance will pay some portion of the fees. The flexibility afforded by a PPO is especially attractive when you or a family member has a specialist, such as a pediatrician, obstetrician, or gynecologist, outside the network. The family member can continue to see their favorite doctors and at least some portion of the fees are covered by the PPO plan.

Your health insurance provider pays most of your healthcare expenses when you are in an Ohio PPO while you are responsible for:

Deductible

The amount of your annual healthcare expenses that you are responsible for paying before your health insurance coverage begins. The health insurance provider “deducts” this amount from your total healthcare charges before paying benefits. The deductible amount varies from family to family, depending on the number of family members on the plan and other variables.

Coinsurance

The amount, usually calculated as a percentage of each healthcare bill, that you are responsible for paying even after your health insurance deductible has been met.

HMO is the acronym for Health Maintenance Organization. Like a PPO, an Ohio HMO is a managed care organization that controls costs through contracts with a network of healthcare professionals. Unlike a PPO, an HMO only pays for healthcare services provided by medical professionals who belong to the managed care network. The care is controlled through the Primary Care Physician, who is your point of contact for everyone in the network. The Primary Care Physician provides referrals to specialist, laboratories, and other healthcare providers within the network. You must have a referral to see another healthcare provider in the network.

The primary advantage of an Ohio HMO is the lower cost. HMO consumers generally pay a fixed fee to gain access to a range of medical services, such as diagnostic and treatment, surgery, hospitalization, and prescription drugs. Most HMOs also offer additional services, such as vision, dental, and psychiatric care. In addition to the fixed premium, Ohio HMO members also must pay set amounts, known as co-payments, for visits to doctors and for other services.

Prescription Drug Coverage

Both PPOs and HMOs cover prescription drugs. Some plans cover both name brand and generic drugs while others cover only generic drugs (when available). Some plans do not cover prescription medications at all. The costs of prescription drugs can be huge, so GetOhioHealthInsurance.com carefully analyzes your family’s medication needs while finding the best plan for you.