California HMO and California PPO

Health insurance consumers enjoy a wide range of options when searching for the ideal plan, including indemnity health care insurance plans; Preferred Provider Organization plans, Health Maintenance Organization plans; California Medicare insurance and Point-of-Sale plans. The most popular of these plans are the California HMO and California PPO plans. Here is an in-depth look at these two kinds of health insurance.

Health Maintenance Organization

As the name Health Maintenance Organization implies, an HMO focuses on maintaining health through wellness care. Because of the emphasis on immunizations and disease prevention, these plans are popular among families with children. These plans cover well child visits, screenings such as Pap smears and mammograms, and other kinds of preventative healthcare. To keep costs down, HMOs enter into agreements with health care professionals who are obligated to follow the organization’s guidelines for care and costs. Policyholders must obtain medical services from healthcare providers within the California HMO network in order to qualify for coverage.
Known as managed care organizations, a Health Maintenance Organization will rely on a corps of experienced physicians to manage the delivery of medical services to health care insurance plan members. These doctors, known as primary care physicians, provide as many medical services as they can for the plan members they serve. If a health care insurance plan member needs to visit a specialist or have a test the primary care physician cannot administer, the primary care doctor makes the necessary referral. The HMO only pays for care made through referrals. It will not pay for visits to specialists made without a referral by the primary care physician.
Because of all the cost-saving measures they employee, a California HMO typically charges lower premiums than other health insurance plans. Plan members must pay set amounts, known as co-payments, for office visits and prescription medications.

Preferred Provider Organization

Short for Preferred Provider Organization, Participating Provider Organization, or Preferred Provider Option, a California PPO is a managed care organization made up of health care professionals bound by agreements to provide medical care to plan members for reduced fees. Like an Health Maintenance Organization, a Preferred Provider Organization emphasizes preventative care, such as physicals and routine screenings such as Pap smears, mammograms, and prostate exams. Unlike an HMO, a California PPO covers a significant portion of medical services obtained outside the network of preferred healthcare providers. The flexibility to go outside the network is a major benefit for people who wish to maintain a relationship with a physician, such as a gynecologist or pediatrician, who practices outside the  network. However, these plans pay less for healthcare services obtained outside the preferred network than they do for care provided within the network.
California PPO healthcare plans cover many health care costs, but the plan member is required pay some expenses out of pocket. These expenses include:

Annual Deductible Amounts

Most plans require the plan member to pay a certain amount of his or her medical expenses each year before the health care insurance plan begins to pay for them. Annual deductibles vary from one health care insurance company to another, and from one California PPO plan to another, based on a range of considerations. San Jose Health Insurance factors the annual deductible amount in with the premium rates to calculate the true annual cost of your health insurance plan.

Coinsurance

Even after the annual deductible has been paid, the PPO plan member also must pay a certain percentage of the total of each medical bill. This amount is known as “coinsurance.”