- Published: November 25, 2021
- Updated: November 25, 2021
- Language: English
- Downloads: 33
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are health schemes aimed at reducing the cost of healthcare by majoring on preventive care. In HMO, one chooses a preferred physician and can only see another one with a referral from the first. Its premiums are relatively lower. There are prepaid monthly premiums (Adler, 7). PPOs are more expensive, and the client can choose to be attended by other physicians outside the program. One pays for the bill then places a claim on the program (Bihari, 7-8).
These plans cover the client who has subscribed to the service and their next of kin, namely wife and/or husband and children. The money for both premiums is co-raised. In HMOs, a member pays a monthly premium, which goes to his health benefit. Therefore, on treatment, one just produces the membership card. It has low out-of-pocket costs. In PPOs, the payment is sponsored by an insurance company, an organization or the employer. The client takes care of the remaining amount in an out-of-pocket basis. The client, however, first pays for the full amount then asks for reimbursement. The reimbursement can be up to 90% for care obtained within network doctors and 30 % for care given by external doctors (agencyinfo. net, 11-13).
Fro both schemes, care is given to the registered members, either through the individual plan or family plan. As of 2011, the HMOs were charging no extra premiums beyond the subscription. In PPOs, clients paid premiums ranging between $500 and $2000 (Insurancelane. com, 3). If the rates increase by 10% annually, then by 2018, the charges will be ranging from $850 to $3, 400. Similarly, if the rates increase by an annual percentage of 7, then the cost will have doubled by mid year 2039. To avoid these hikes in increase of healthcare cost, the government should provide more subsidies for the public health schemes.
Agencyinfo. net. Health Insurance. 2011. Web, Dec. 16th 2011, http://www. agencyinfo. net/iv/medical/types/hmo-ppo-pos. htm
Adler, Andrea. HMOs Explained. 2009. CBSNEWS, February 11, 2009. Web, Dec 16th 2011, http://www. cbsnews. com/stories/2001/05/01/national/main288749. shtml
Bihari, Michael. HMOs vs. PPOs – What Are the Differences Between HMOs and PPOs? Web, Dec 16th 2011, http://healthinsurance. about. com/od/understandingmanagedcare/a/HMOs_vs_PPOs. htm
Insurancelane. com. HMOs vs. PPOs. 2007. Web, Dec 16th 2011, http://www. insurelane. com/health/hmo-vs-ppo. html