While it’s great to have a wide range of health plan options available to you, it can also be a little daunting. Untangling an HMO from a PPO can leave you with abbreviation fatigue. But your research doesn’t have to be DIY. We’re here to help with the ABCs of Michigan’s most common health plan types so you can make the most of the one you choose.
Three of the most common types in Michigan are HMO, PPO and narrow network plans. Each balances costs and coverage differently, so it’s important to know the differences between them.
What is an HMO?
An HMO or “health maintenance organization” plan is the most common type in Michigan. An HMO helps keep costs down while still offering reliable care by having you see in-network providers only.
How it works: You’ll need to choose a primary care provider (PCP) to oversee your care. You’ll be able to use doctors and hospitals that are part of a large network and can often even see in-network specialists without a referral. But keep in mind that you won’t be covered for out-of-network services unless it’s a medical emergency.
Insider tip: Make sure you’re enrolled in a plan with a large HMO network. This gives you access to a wider range of doctors and hospitals.
What is a PPO?
A PPO or “preferred provider organization plan” prioritizes flexibility and lets you get care whether you choose in- or out-of-network doctors and facilities. That flexibility comes with a higher cost, and higher premiums for care out of network, but allows you to see any provider you want.
How it works: The amount you pay for services will depend on whether you use in-network or out-of-network providers. You’ll have the option of going outside of the network by paying extra for services. The choice is yours.
Insider tip: You’ll save money by using doctors and hospitals in your PPO network. Only go out of your PPO network for specialized care or major health concerns.
What is a narrow network?
Narrow Network plans have much lower premiums and provide access to quality care within a specific network of doctors and affiliated providers. If you’re happy with the hospitals and physicians included in the narrow network (or you already see a doctor in the network you’re considering) and want to keep your premium costs down, this might be the option for you. Technology makes a Narrow Network plan more open as well. Priority Health Narrow Network plans offer virtual care options, like virtual urgent care and lets you manage your health from the comfort of your home or office through your computer or mobile device.
How it works: Agreements between a health insurance company and providers keep costs down within a narrow network. That means lower costs for services, but only with those specific providers. If a doctor, lab or hospital isn’t in the network, you’ll have to pay 100% of the cost — except in the case of a medical emergency.
Insider tip: Understand exactly where you can (and cannot) go for care. Some narrow networks use major, regional health care systems, so you may have more options than you realize.
If you’d like to learn more about health plans and how to save on coverage costs, visit the Individual and family health plan Learning Center. Regardless of which plan type is right for you, Priority Health has one that will meet your needs, so you can get care when and where you need it.
