By Susan Braden
One of the questions we hear often is, “Is the Careington 500 Series plan an HMO, PPO or Discount Plan?” As a consumer, it can be difficult to discern the differences between these three types of coverage plans. So, to make things simple, below are listed some definitions of these terms to help you better navigate the insurance world.
A form of health or dental insurance combining a range of coverages on a group basis. A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no deductibles. However, only visits to professionals within the HMO network are covered by the policy. All visits, prescriptions, and other care must be cleared by the HMO in order to be covered. A primary physician within the HMO can handle referrals.
A health or dental care organization composed of physicians, hospitals, or dentists that provide services at a reduced fee. A PPO insurance is similar to an HMO, but care is paid for as it is received instead of in advance in the form of a scheduled fee. PPOs may also offer more flexibility by allowing for visits to out-of-network professionals at a greater expense to the policyholder.
An organization that contracts a particular set of prices with a group of health or dentistry providers, such as the Careington 500 Series. Members of the organization go to in-network providers and pay immediately based on pre-contracted fee schedules. Payment plans are made at the discretion of the provider.