An HMO health plan is designed so that you have care personalized to you. Because out-of-network providers don't have a contract with us, we can't control how much they charge you. Updated November 14, 2022 Expert Reviewed Editorial Standards SmartFinancial Offers Unbiased, Fact-based Information. If you forget or aren't sure what type of health insurance plan you have (like an HMO or PPO), you can find out on your BCBS ID card. How can I choose a primary care physician for my HMO plan? You don't need a referral to see a specialist. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. An HMO generally only covers care received from the plans contracted providers, known as in-network providers. If you're a member, you can find your PCP or your medical group listed on the front of your Blue Cross and Blue Shield of Illinois (BCBSIL) member ID card or by logging in to Blue Access for MembersSM. A PPO plan is also generally more expensive than an HMO plan. Learn more about Making Insurance Work For You. PPO plans offer higher monthly premiums in exchange for a larger provider network and more medical freedom. Your card contains key information about your health insurance coverage that is required when you need care or pick up a prescription at the pharmacy. PPO plans have more flexibility than HMO plans. One option is Adobe Reader which has a built-in reader. The cost of health insurance is different for everyone. Year after year, BCBSTX HMO health plans have proven to help improve member health results and lowered their overall cost of care because health issues are managed before they get serious. Anthem MediBlue PPO is a Part C Medicare PPO plan that gives you the flexibility to work with any doctor or specialist, in or out of network, no referrals needed. With one doctor to coordinate your care, an HMO health plan is easy to use and may be just what youre looking for. You have to live in of one of these70 countiesin Michigan for at least six months out of the year to get one of our HMO-POS plans. You can see providers that are in-network or out-of-network. With a PPO, or preferred provider organization, theres more flexibility where you seek care. Many HMO providers are paid on a per-member basis, regardless of the number of times they see a member. The main differences between HMOs and PPOs are affordability and flexibility. Understanding plans To better understand our plans, it helps to understand how the different plan types work and your related healthcare costs. Coverage for in-network providers only, unless its an emergency. Blue Cross Community MMAI (Medicare-Medicaid Plan), Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage, Learn more about Making Insurance Work For You. National Accounts, Posts about using health Insurance and managing your health, Collections of learning resources and links to services, For Sydney Health users connect with others and find care programs. You dont need a primary care physician. Simplified. An HMO, or Health Maintenance Organization, is designed to keep costs low and predictable. PPO: With a PPO, you have a network of preferred providers. A decision between an HMO and a PPO should be based on whats most important to you: cost or flexibility. National plans are the best option if you or your family live or work outside Washington, D.C., Maryland or Northern Virginia. Register Now. Important Information About Medicare Plans. Contact Us | Blue Cross Blue Shield You would first go to your primary care physician, whod examine you. BlueChoice Advantage Gold 800one of our top three plansis a POS plan. HMO plans require that you choose a primary care physician and get all specialist referrals through your PCP. However, customers using a Medicare Advantage plan may need referrals for specialist visits. A Medicare HMO is a type of plan in which you must get most of your care from a specific network of doctors and hospitals unless it is an emergency. In addition, some sites may require you to agree to their terms of use and privacy policy. You can also see a specialist without getting a referral. Think of it as a trade-off. Learn More Also, neither company advertises a discounted rate if you purchase a family or couples plan, but choosing a high-deductible policy can help you get a lower monthly premium. Blue Cross has a different app for each state, and the app features vary. How should I prepare for my first doctor's appointment? Because of that, purchasing a Medicare plan through Aetna is a good option for some people. This new site may be offered by a vendor or an independent third party. Typically higher monthly premiums and out-of-pocket costs than for HMO plans. Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands Outside the United States Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. Your costs are also kept low because the doctors and hospitals in the HMO provider network agree to offer their services at a set price. Your potential employers HR team will often have a chart available that compares the details of the specific plans they offer, and thats a great place to start. Regional plans are a good option if you and your family live or work in Washington, D.C., Maryland or Northern Virginia. Your member number, also known as your identification number, is listed directly below your name. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. They are not recommended if you live outside this area. We're here to help make your Medicare decision simple and stress-free. Most people have health insurance through their employer, but you can also get coverage through your states insurance marketplace or you can get coverage independently through a private provider. Coverage area: . Learn about key dates for enrolling in or changing a Medicare Advantage plan. Blue Advantage from Blue Cross and Blue Shield . Most PDF readers are a free download. You can then choose a Medicare Advantage HMO or PPO plan that works for you. Get access to your member portal. Usually more expensive than an HMO or POS plan. Which is more important to you: lower costs or more flexibility? These questions may help you choose. In addition, some sites may require you to agree to their terms of use and privacy policy. Once you choose a plan and buy a policy, your coverage will begin after a short waiting period. When your BCBS ID card arrives in the mail, take a moment to look for these five things: Check your new card to ensure details like the spelling of your name and the type of plan you selected are correct. Knowing how your plan works may save you time and money. Most drug lists are updated monthly. You dont need a primary care physician. Aetna vs. Blue Cross: Which Should You Choose? - Investopedia The site may also contain non-Medicare related information. HMO plans require you to stay within their network for care, unless its a medical emergency. Older adults can choose a geriatric doctor. However, you can also purchase coverage outside of open enrollment if you have experienced a qualifying life event. You may also need to pay a deductible before your coverage benefits begin. Coordinating all your health care through your primary care physician means less paperwork and lower health care costs for everyone. Find a Doctor | Blue Cross Blue Shield Each type of plan offers different types of coverage based on cost and networks, so the best plan for you depends on your budget and your doctor preferences. Includes benefits of an HMO and access to out-of-network providers. Aetna specifically has a number of negative reviews related to its customer support agents. In most states, Blue Cross offers Bronze, Silver, and Gold plans with varying out-of-pocket maximums and deductibles. All these plans use a network of doctors and hospitals. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc., CareFirst Advantage DSNP, Inc., CareFirst Community Partners, Inc., CareFirst BlueCross BlueShield Community Health Plan District of Columbia, CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. This makes HMO plans a more economical choice than PPOs. As an alternative, you can apply through your states insurance marketplace to see what Blue Cross and Aetna plans are available with premium subsidies. Aetna and Blue Cross both offer online quotes and, in some cases, you can purchase a policy through the website. There are lots of doctors out there. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Any information we provide is limited to those plans we do offer in your area. Your PCP will refer you to a specialist for more serious illnesses. What to know about 2023 Medicare Advantage Plans. If your group number is available, you'll find it directly below your member number. In addition, some sites may require you to agree to their terms of use and privacy policy. What are the advantages & disadvantages of Medicare Advantage? It's a type of health plan that lets you choose where you go for care, without a referral from a primary care physician (PCP) or having to only use providers in your plan's provider network. It typically has higher monthly premiums and out-of-pocket costs like copays, coinsurance and deductibles. Medicare Advantage: Compare Medicare Advantage Plans. If you're a BCBSIL member, register or log in to Blue Access for MembersSM, your secure member website, for a personalized search based on your health plan and network. Individuals attempting unauthorized access will be prosecuted. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. To review Aetna and Blue Cross, we focused on some of the most important factors to consider when comparing health insurance companies. Medicare HMO vs. PPO: What is the Difference? | Anthem You can also change your Medicare Advantage plan type during theMedicare Open Enrollment Period,which is January 1 to March 31. Cost-sharing refers to the part of your healthcare costs that your plan doesnt pay. And if you want the best of both worlds, a POS plan could work for you, just know that you will have to pay a portion of the out-of-network care costs. Learn more about Making Insurance Work For You. Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. Both companies have an online member portal that allows you to see your policy information, view the status of claims, and make updates to your plan. Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. HMO plans We provide health insurance in Michigan. Access to certain doctors and hospitals, called your HMO provider network, which helps control how much you pay for health care. State and Federal Privacy laws prohibit unauthorized access to Member's private information. 5. Blue Cross Blue Shield If you do a lot of traveling within the U.S. and you want the convenience of having one doctor coordinating all your care, an HMO-POS plan might be right for you. Provider networks are different for HMO and PPO plans: HMO: With traditional HMOs, you need to use a specific provider network and choose a primary care doctor. Women and girls can choose an OB/GYN or a WPHCP as their PCP. An HMO, or Health Maintenance Organization, is designed to keep costs low and predictable. In some states, the app also allows you to pay your bills, research drug prices, submit out-of-network claims, and get connected with the 24-hour nurse hotline. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. HMOs are more budget-friendly than PPOs. PPO plans give you flexibility. Knowing the differences between plans can help you choose the one thats right for your health care needs and budget. Aetnas app allows you to search for doctors, view your claims, see your plan details, get your ID cards, track your spending, pay approved claims, and even compare costs for medical visits and procedures. Plan types refer to how plans provide coverage and from which network of providers you receive care. Coverage for in-network and out-of-network doctors. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. However, like an HMO, there are no out-of-network benefits. A PPO plan can be a better choice compared with an HMO if you need flexibility in which health care providers you see. Learn more about making insurance work for you. Under the HMO benefits of the plan, you have access to certain doctors and hospitals, called your HMO provider network. We also paid attention to the network size and area of availability for both companies. You can see providers in the BlueChoice network for the most savings or use the PPO network and pay slightly more but still be protected from balance billing. As you look at plans, you may notice that some plans are HMOs and some are PPOs, but what does that mean? External link You are leaving this website/app (site). However, like with a PPO plan, you can see out-of-network health care providers but at a higher cost. So, for instance, if you had a baby, your childs birth certificate would be sufficient. What Is An HMO POS | Blue Cross and Blue Shield of Texas Member Discounts Take advantage of member-only discounts on health-related products and services. The protection of your privacy . Learn about important differences between a Medicare HMO and PPO plan. A primary care physician (PCP) who you see for routine check-ups, physicals, colds and flu. You dont need prior approval or a referral from a primary care doctor. How can I choose or change my primary care physician? But if you have a doctor you prefer to see, it might be easier to visit him or her with a PPO plan. Our Medicare Advantage plans feature Essential Extras benefits at no added cost. While HMO and PPO plans are the 2 most common plans, especially when it comes to employer-provided health insurance, there are other plan types you should know about, including EPO and POS plans. Getting private health insurance can be a good option, but its not the right choice for everyone. An early diagnosis and treatment can keep many common health issues from getting worse. Customer value is our cornerstone. It typically has higher monthly premiums and out-of-pocket costs like copays, coinsurance and deductibles. Power Finds. If you use a provider that isnt in the HMOs network, known as an out-of-network provider, the plan typically wont cover your visit unless its an emergency. The HMO network may include care and services from: To avoid getting big bills, make sure you stay in the HMO provider network. A primary care provider (PCP) who you see for routine check-ups, physicals, colds and flu. If you need to see a specialist, your primary care doctor must give you a referral. Your PCP is your partner in keeping you healthy. All rights reserved. What to Know About HMOs and PPOs - WebMD Your BCBS ID card has your member number, and in some cases, your employer group number. Find out how Anthem can help fill this gap. Helpful hint:No matter which plan you have, before you need care, get to know your plan, what's covered and where you can go for care. If you rarely see the doctor and care more about paying a low premium, an HMO might be a better choice. Now is the time to find the right Medicare plan that fits your changing healthcare needs. Learn more about these programs and who qualifies for each. Members may also seek emergency care from the closest emergency room. "Special Circumstances (Special Enrollment Periods).". Think higher cost with greater flexibility.

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