Types of Health Plans: The Road Map


So you’re ready to cruise towards your
medical plan options. But now that you’re sitting at the
intersection, you see all these different types of
health plans. How do you decide which way to turn? Let’s take a look down each road with
Ted and explore the options more closely. On the right is PPO Highway. If you turn this direction, you can see
any in-network provider at any time without a referral. You can even take an off-ramp to an
out-of-network doctor, but you’ll pay a hefty toll. On PPO Highway, you choose your own route,
but you generally pay more for that freedom in both premiums and services. To the left is HMO Boulevard. With access to this gated community, you choose one primary care physician and
“park” while they coordinate all your care. If you need to see a specialist, your PCP
will refer you to a provider in their exclusive HMO network. There are no off-ramps here. So if you
leave the neighborhood to see an out-of-network doctor, it won’t be covered
and you’ll pay the costs in full. But as long as you let your primary doctor
map your route, you’ll typically pay less for high-quality
coverage and services. And there’s still another road. Straight ahead on
Coordinated Care Model Avenue you need to “park” at a Medical Home, where
a primary doctor will coordinate your care and refer you to other providers as needed. You may also have access to those out-of-network
off-ramps (and their hefty tolls) if you feel the need to take a road trip. So what is a Medical Home, and why do
you need to park there? Think of your Medical Home as the building
where your primary doctor lives. It could be a big multiplex with
lots of providers, or it could be a tiny house where
only your PCP lives. The key is the primary doctor in your
Medical Home has close relationships with their CCM family and friends. Those other CCM providers may live in
the same house, or next door, or further down the Avenue, but they all talk to
each other often. So everyone involved in your care knows
the latest news. By “parking” and letting your PCP guide
your healthcare journey, the whole CCM community can work
together to get you the right care at the right time. When choosing your health plan, consider
your personal needs and preferences. If you’re someone who likes to take the
wheel and explore the open road without many restrictions, a PPO might be best
for you. If there’s an HMO or CCM option in your area,
you could save some money, and some stress, by etting your PCP map
your route and coordinate your care. No matter which way you turn, OEBB ensures all your health plan options
provide safe, effective care. So choose the path that’s best for your
medical needs, and your pocketbook and you, and Ted, will be on the fast
track to good health!

Daniel Yohans

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