The main difference is that you can see doctors outside your network in some cases. If you want to be able to coordinate your own health care, a PPO plan might be right for you. But if you stay in your network, you’ll pay less. You can see doctors inside or outside your network. PPO plans have more flexibility than HMO plans. If you want low monthly premiums and copays and you don’t travel much, an HMO plan might be right for you. When you have an HMO plan, you choose a primary care physician who works as your partner. They coordinate all your care and can refer you to trusted doctors and specialists in your network. It's important to note that, with an HMO plan, most health care isn't covered outside your network. PPO stands for preferred provider organization.HMO stands for health maintenance organization.These acronyms all signify different health plan types: After that point, you pay the full amount each day. And if you're in the hospital or a skilled nursing facility, Original Medicare only pays for a certain number of days. There's no cap on what you pay out of pocket. Original Medicare doesn’t have an out-of-pocket maximum. This is called the out-of-pocket maximum. When you reach a certain amount, we pay for most covered services. When you have a Blue Cross plan, we track all the costs you pay – deductible, copays and coinsurance. We pay the Original Medicare deductibles for you. Original Medicare has its own deductibles, but if you have a Medicare Advantage plan, you don't have to worry about them. Most Medicare Advantage plans have separate medical and pharmacy deductibles. After you reach your deductible, you’ll still have to pay any copays or coinsurance. For most services, you'll pay the full cost until you reach the deductible. DeductibleĪ deductible is the amount of money you pay for care before your plan starts paying. You pay 20 percent coinsurance for most services with Original Medicare. Our Medicare Advantage plans use copays for most services. Your health insurance plan pays the rest of the cost. Copays and coinsuranceĪ copay is a fixed amount of money you pay for a certain service. They may call the home pharmacy for your or they may ask you to call your home pharmacy, but either way, you can avoid having to go to an urgent care clinic to get a new prescription by just transferring an existing prescription.īeing a smart healthcare consumer can be challenging-but doing it well can result in you receiving excellent care and saving hundreds of dollars.These terms all describe money you pay toward health care when you have a health insurance plan. You do this by going to a pharmacy at your travel location, telling them you have refills at your home pharmacy and giving them the name and number of your home pharmacy.
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