I’ve never been a huge fan of HMO’s, but taking the Affordable Care Act into consideration, HMO’s just moved up a notch. Why? Consider this… Under the ACA, provider networks have gotten very narrow, and many providers don’t accept Mirrored Plans* or plans purchased through Covered CA – and some doctors don’t accept individual plans at all.
So… if you have a PPO and need a specialist, a lab test or other provider, you have to be very careful that your provider is in your PPO network. Otherwise, you could be responsible for heavy out-of-network charges.
However, with an HMO, your primary care provider refers you to specialists and other providers, and he/she will always refer you in-network… so you don’t have to worry about additional charges.
An additional benefit is that certain HMO’s are often priced well below PPO’s. Check with an experienced, licensed agent for pricing.
*Plans that are available both on Covered CA and direct from the insurance carrier
Author: neil steinman
Neil Steinman is the principal of Orange County Health & Life Insurance in Orange County, CA – and has been serving the needs of California residents for nearly 20 years.