California Health Insurance Plans – HMO vs PPO Plans

Are you looking for California health insurance plans? If you are you’ve come to the right place. With several hundred of health insurance plans available in California trying to find the right plan can be rather intimidating.  In this article we will talk about the two most common types of plans you will come across and how you can determine which type of plan will best fit your needs.

HMO California Health Plans

HMO is short for health maintenance organization. With an HMO style plan you are required to choose a primary care physician who will manage your health. Your primary care physician will have to give you a referral if you need to see a specialist or to have certain medical procedures done. All medical proved must also be in the HMO network.  Your referral also has to be approved by the insurance provider before you can receive treatment. Referrals typically require paper work and lots of red tape to get approved. HMO’s are CO-Pay based meaning that you pay CO-Pay for most medical treatment instead of having to meet a deductible. CO-Pay’s vary in amount based on preformed service.

Some of the major benefits of an HMO style plan are the CO-Pays and that they include maternity coverage. An HMO should be considered if you a looking for lower out of pocket cost and don’t mind having to get referrals for specialist and medical testing. HMO’s are also the most expensive individual health insurance in California. HMO’s are offer by Anthem Blue Cross, Blue Shield Ca, Health Net, Kaiser and PacifiCare in California.

PPO California Health Plans

PPO is short for Preferred Provider Organization. With a PPO style plan you have more flexibility when it comes to your health care needs. You are not required to select a primary care physician nor do you have to get a referral to see specialist or for medical testing. With a PPO you can also seek treatment outside of the network, but if you seek treatment out of network be prepared to pay higher out of pocket cost.

A PPO plan typically provides office visits and prescription drug coverage for a CO-Pay amount but hospital stays, emergency room visits, surgeries and medical test are often subject to a deductible. The deductible is the dollar amount the patient must pay before the insurance provided cost sharing. Once the deductible is satisfied the insurance company will provide cost sharing saving till the out of pocket maximum is met. One the out of pocket maximum is met the insurance company will pay 100% of all covered medical expenses.

PPO’s are usually the least expensive California health insurance plan. They should be considered if it’s important to you to be able to choose you own doctor and specialist. A PPO plan will give you more control of you health and medical treatment. PPO’s are provided by most California health insurance companies except for Kaiser.

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