Difference Between Insurance Plans

PPO vs. HMO vs. Medicare
May 19, 2016 at 2:26 pm

PPO vs. HMO vs. Medicare

“It is health that is real wealth and not pieces of gold and silver.”

Mahatma Gandhi signified the importance of health in such a small yet beautiful quote. Health is of at most importance in every person’s life. We can enjoy all the benefits in life only when we have a fit and healthy body. To take care of such an important gift and to support us in case of emergencies there have been a number of insurance plans put forward. While all these may seem similar, they may differ in terms of a few factors which will be briefed in this article over 40 singles.

Preferred Provider Organization (PPO)

PPO is considered as one of the most popular plans in the individual and family market. This health insurance plan makes a tie-up with medical practitioners such as doctors and hospitals. All the hospitals and the doctors who belong to the tie up fall under the network of Preferred Provider Organization. The main need for this network is that, when a patient who holds a PPO plan visits a doctor or hospital under this network he can pay lower rates when compared to the other patients 1.

The policy holders not only benefit from the in-network medical practitioners, but also if they visit a doctor who is not in the network. But the out-of-network services have lesser benefits when compared to the in-network services. This plan facilitates a person when one does not want to seek referrals before he/she visits the doctor. It also provides you the freedom to choose your physician Truth About Six Pack Abs.

Health Maintenance Organization (HMO):

Unlike PPO, HMO requires the policy holder to choose one primary physician. In case you need to consult any other physician, you will require a referral, except in the case of emergencies. This referral is often given by the primary doctor itself in case the patient needs a specialist to treat him/her 2.

This plan will help us with less paper work as it involves only a single medical practitioner but it does not benefit us once we are consulting a doctor out of the network. This rips off the freedom of the insurance policy holder in making a choice. However it offers a lower premium as it is restricted only to the network 3.

Medicare:

Medicare is a federal health insurance program for people who are 65 or older. It also covers certain younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure which may require dialysis or kidney transplant).

There are four major coverage in Medicare.

  • Part A specializes in hospital insurance covers in-patient hospital stays, hospice care, nursing facility and some home health care facilities 4
  • Part B specializes in medical insurance which covers certain medical practitioners, medical supplies, outpatient care and other preventive services 4.
  • Part C is the Medical Advantage Plans which is a type of medical health plan offered by a private company which holds a contract with Medicare to provide the policy holder with all Part A and Part B benefits. Most Medical Advantage Plans also offer prescription drug coverage. Medical Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-service Plans, Special Needs Plans and Medicare Medical Savings Account Plans 4.
  • Part D specializes in Prescription Drug Coverage. It simply adds up Prescription Drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee-for-service Plans and Medicare Medical Savings Account Plans. These plans may be offered by insurance companies or other private companies approved by the Medicare 4.

Which insurance plan is more preferable?

If you are looking for a medical insurance plan which would help you with recovery and rehabilitation, then Preferred Provider Organization (PPO) is recommended for you. PPO offers coverage for substance abuse. According to the Substance Abuse and Mental Health Services Administration, a person stays in an inpatient treatment center at an average length of 30 to 105 days 5. Most of them who come out with successful results may even stay for about 120 days 5. PPO might limit the stay based on your policy. It covers most of the rehabilitation stays and is the most preferable insurance plan when you seek treatment for substance abuse as an inpatient or as an outpatient.

“Take care of your body; it’s the only place you have to live.”

Insurance Plans play a major role in supporting a person when he seeks recovery. Such plan must be flexible and must meet the requirements of the insurance holder making the whole process easy. These plans must motivate the patients to undergo recovery rather than being as an obstacle for them.

There is no bigger and better wealth than health. To protect such an important element in our life it is recommended to take time and select a policy which covers most benefits and which suits the requirements of the insurance policy holder. 

“Strength grows in the moments when you think you can’t go on, but you keep going anyway! “

An enormous amount of strength is required during the phases of addiction recovery. And to keep this strength intact, a lot of support is required for everyone around. If there are some discrepancies in your insurance cover, you might not feel very much comfortable with the recovery phase worrying about the bills. Never let any single obstacle fall in your way of recovery. Start this by choosing the right insurance plan for you.

“Faith is taking the first step even if you don’t see the whole staircase. “

Faith in yourself is required when you face the long road of recovery. This long road may not seem very long when you have grit and determination in yourself. A small amount of belief and faith may make great wonders in life. Trust is of at most importance when you undergo recovery. Every day is a good day, hence start your recovery today!