HMO vs. PPO: Kudziwa kusiyana kwa mapulani azachipatala

Kampani

Kusankha inshuwaransi yoyenera ya inu ndi banja lanu ndi ntchito yovuta. Ndi kukwera mtengo kwa chithandizo chamankhwala, zitha kukhala zovuta kuti mupeze njira yotsika mtengo komanso dongosolo lomwe limapereka chisamaliro chabwino koposa. Gawo loyamba posankha ndikumvetsetsa momwe dongosolo lililonse limagwirira ntchito. Munkhaniyi, tikufanizira mitundu iwiri yamapulani-HMO vs. PPO-ndikuwona mawonekedwe a iliyonse.

Kodi HMO ndi chiyani?

AnHMO, yomwe ndi yochepa kwa Health Maintenance Organisation, ndi mtundu wa mapulani azaumoyo omwe amagwiritsa ntchito madokotala oyang'anira (PCPs) kuthandiza kuthandizira chisamaliro cha odwala awo. Amagwiritsa ntchito gulu la madokotala, zipatala, ndi othandizira ena azaumoyo. Mukasankha dongosolo la HMO, mumasankha PCP pa intaneti. PCP yanu nthawi zambiri imagwirizanitsa ntchito zomwe mumafunikira, ndikupereka mwayi wopita kukayezetsa komanso kuyendera akatswiri, komanso kulandira malipoti ndi zotsatira za mayeso. Nthawi zambiri samasamalira chisamaliro cha intaneti, kupatula pakagwa mwadzidzidzi.

PPO ndi chiyani?

PPO, yomwe imayimira Preferred Provider Organisation, ndi mtundu wamadongosolo azachipatala omwe amakhalanso ndi gulu la madotolo, zipatala, ndi othandizira ena; komabe, amapereka zosinthasintha zambiri akafuna chisamaliro. Amalipira chithandizo chamankhwala ena kunja kwa netiweki, koma nthawi zambiri amatero pamtengo wotsika ndipo munthu yemwe ali ndi inshuwaransi atha kukhala ndi gawo la mtengo wake wonse. Simusowa kutumizidwa kuti mukawone katswiri.

HMO vs. PPO: Kodi pali kusiyana kotani?

Kuphatikiza pa kusiyana pakati pa netiweki komanso kunja kwa netiweki komwe kumalumikizidwa ndi ma HMO ndi ma PPO, pali zinthu zingapo zomwe zimakhudzana ndi kampani yama inshuwaransi azaumoyo. Zotsatirazi zikufanizira zina.

Ma PPO ali ndi ma network akulu opereka

Onse a HMO ndi ma PPO ali ndi gulu la madokotala, zipatala, ndi othandizira ena azaumoyo. Ndalama zomwe mumatulutsa m'thumba ndizochepa mukamagwiritsa ntchito azachipatala pamaneti awa.

Ma HMO amafunikira kuti musankhe omwe amapereka chithandizo choyambirira kuchokera pa intaneti. Izi nthawi zambiri zimakhala zoyipa zazikulu pantchitoyo - kuti nthawi zambiri mumangokhala ochepa omwe akupatsani. Kuphatikiza apo, nthawi zambiri mumayenera kuwona PCP musanawone akatswiri. Chodziwikiratu chomwe chimafunikira pakatumizidwa ndi chisamaliro cha amayi kapena azimayi. Simukusowa kutumizidwa kuti mukawone madotolowa, komabe akuyenera kukhala mkati mwa netiweki yanu.

Mapulani a PPO ali ndi malire ochepa pamaneti omwe amapereka. Muli ndi kusinthasintha kwakukulu, ndipo maukonde a PPO nthawi zambiri amakhala akulu kuposa ma HMO. Ambiri safuna kuti musankhe dotolo woyang'anira mukalembetsa mapulani, ndipo amalipira ena chisamaliro chapanja , Nthawi zambiri amakhala ndi copay yayikulu kapena chiwongola dzanja cha ndalama. Nthawi zambiri pamakhala magawo omwe amakupatsani, pomwe gawo 1 limakhala lomwe limakupatsani ma network, tier 2 imalipira ndalama zochepa (komanso ndi mitengo yotsika mtengo ya ogula), ndipo gawo 3 limalipira ndalama zotsika kwambiri (komanso ndi mtengo wotsika kwambiri wa ogula).

Ma HMO ali ndi mtengo wotsika mthumba

Mukazindikira mtengo wanu wonse wa inshuwaransi yazaumoyo, muyenera kuphatikiza ndalama zomwe mumalipira m'thumba. Izi zikuphatikiza ndalama zoyendetsedwa, zochotseredwa, kusungitsa ndalama, ndi zolipira.

Choyamba

KU umafunika ndi ndalama zomwe mumalipira pamwezi kuti mukhale ndi inshuwaransi yazaumoyo ngakhale mutazigwiritsa ntchito mweziwo. Mapulani otsika kwambiri amakhala ndi ma deductibles apamwamba komanso mosemphanitsa. Ngati muli ndi inshuwaransi yazaumoyo kudzera kwa abwana anu, ndalamazi zimachotsedwa pa zolipira zanu ndipo zimaperekedwa kwa omwe amakupatsirani inshuwaransi.

Ma HMO amakhala ndi ndalama zochepa kuposa ma PPO koma kusiyana kwake sikungakhale kwakukulu.

Zodula

Zodulidwa pachaka ndi ndalama zingati zomwe mumagwiritsa ntchito kuthumba ndalama zomwe kampani yanu ya inshuwaransi isanapereke. Mutha kukhala ndi zochotseka zapadera pazachipatala ndi gawo lamankhwala la pulani yanu. Zodulidwa zitha kukhala mbali imodzi ya dongosololi - monga kuchipatala kapena mankhwala - zomwe ziyenera kukhutiritsidwa asadalipire chilichonse.

Ma HMO amakhala ndi zotsitsa zochepa kuposa mitundu ina yamapulani, kuphatikiza ma PPO. Ma HMO ena alibe zochotseredwa zilizonse.

Coinsurance

Coinsurance ndi gawo la ndalama zamankhwala zomwe mumayenera kulipira mukakumana ndi kuchotsedwa kwanu. Mwachitsanzo, ngati muli ndi chitsimikizo cha 20% ndikulandila ndalama za dokotala $ 1,000, muli ndiudindo wa $ 200, ndipo kampani ya inshuwaransi idzalipira zotsalazo.

Ma HMO nthawi zambiri samakhala ndi chitsimikizo.

Copay

Kukopera, kapena kukopera , ndi ndalama zomwe mumalipira mukawona dokotala kapena mukalandira mankhwala; nthawi zambiri zimasiyanasiyana kutengera ntchito yazaumoyo. Mwachitsanzo, mukapita kukaonana ndi dokotala wanu wamkulu, copay yanu ikhoza kukhala $ 20; $ 40 kwa katswiri; kapena $ 250 paulendo wachipinda chadzidzidzi. Zolemba pamakalata omwe amagwiritsidwa ntchito pamankhwala nthawi zambiri amakhala pamiyala potengera mankhwala omwe ali ndi generic komanso dzina lodziwika.

Ma HMO amafunikira ma copay posamalira zodzitetezera ndipo ma PPO amafunikira ma copay pamachitidwe ambiri. Chidziwitso: Ma Copays sagwiritsidwa ntchito kuchotseredwa pachaka.

Kutuluka mthumba

Kuphatikiza apo, muyenera kudziwa za mapulaniwo Kutuluka mthumba . Mukafika ndalamayi mchaka chimodzi, kampani ya inshuwaransi imakulipirani ntchito 100% kwa chaka chotsala cha kalendala ija.

Ndondomeko zonse zamsika zimakhala ndi malire. Za 2020 , malire otuluka m'thumba ndi $ 8,150 kwa anthu komanso $ 16,300 yamabanja.

Kubwereza: HMO vs. PPO
	HMO	PPO
Mtengo	Ndalama zoyambira zimakhazikitsidwa pazinthu zosiyanasiyana, monga komwe mumakhala, zaka zanu, komanso ngati muli ndi dongosolo la banja. Mwambiri, ndalama zoyendetsedwa ndi HMO ndizotsika kuposa mapulani ena (monga ma PPO) omwe amakupatsani kusinthasintha. Kuphatikiza apo, mutha kulipira ndalama zochepa kuchotsera, ma kopi, ndi zolemba ndi ma HMO.	Ndalama za PPO ndizokwera kuposa ma HMO. Mumamalipiranso zambiri zolipirira mthumba monga ma deductibles ndi ma copay.
Mtanda	Muyenera kukhala mkati mwa omwe amapereka ma netiweki kuti musunge ndalama.	Muli ndi kusinthasintha kochepera pa netiweki ndikupezabe ndalama zolipirira zaumoyo.
Zolemba	Muyenera kutumizidwa kuti muwone za dokotala aliyense yemwe si dokotala wanu wamkulu.	Simusowa kutumizidwa kuti mukawone madotolo / akatswiri ena.

Ndipo Kuposa PPO HMO?

Kutengera kusinthasintha kwa ma PPO, anthu ambiri amasankha mtundu wamtunduwu. Anthu makumi anayi mphambu anayi peresenti ya omwe adalembetsa ku PPO, ndipo 19% adalembetsa ku HMO, malinga ndi Kafukufuku Wathanzi wa 2019 wa Olemba Ntchito . Koma funso labwino ndilakuti, Ndi mtundu wanji wamapulani wabwino kwambiri kwa ine? Ma PPO onse ndi ma HMO ali ndi zabwino komanso zovuta. Zomwe zili zabwino kwa inu zimatengera zosowa zaumoyo za banja lanu.

Nthawi zambiri, HMO ikhoza kukhala yanzeru ngati ndalama zotsika ndizofunikira kwambiri ndipo simusamala kugwiritsa ntchito PCP kuyang'anira chisamaliro chanu. Komabe, muyenera kuwunikiranso maukonde a pulani yoyamba, popeza ena akhoza kukhala ochepa. PPO itha kukhala yabwinoko ngati muli ndi adotolo kapena gulu lazachipatala lomwe mukufuna kusunga koma simalo a netiweki yanu.

Mafunso omwe mungafunse mukamaganizira dongosolo la HMO ndi awa:

• Kodi madokotala anga ali mu netiweki ya HMO? Ngati sichoncho, kodi ndine wokonzeka kusintha omwe amapereka?
• Kodi mtengo wa zolipirira pamwezi ndi chiyani?
• Kodi ndalama za copay ndi ziti?
• Kodi banja langa limapita kangati kwa dokotala? Kodi chaka chonse ndimalipira chiyani?
• Kodi pali aliyense m'banja langa amene akudwala kapena akusowa chithandizo chamankhwala chochuluka?
• Kodi ndine wokonzeka kulandira thandizo ndikawona wothandizira zachipatala kupatula PCP yanga?

Mafunso omwe mungafunse mukamaganizira dongosolo la PPO ndi awa:

• Kodi madokotala anga ali mgululi? Ngati sichoncho, kodi ndine wokonzeka kulipira ndalama zambiri?
• Kodi pali deductible yosamalira ma network?
• Kodi mtengo wa zolipirira pamwezi ndi chiyani?
• Kodi kuchezera kwa dokotala kumawononga ndalama zingati, kutengera kuchuluka kwa ndalama za ndalama?
• Kodi ndingathe kuyerekezera ndalama zomwe ndimagwiritsa ntchito kuthumba?
• Kodi pali wina m'banja mwathu yemwe ali ndi zamankhwala zotumikiridwa bwino ndi omwe amapereka kunja kwa Gawo 1 kapena yemwe sitimatha kuwona ngati tidalembetsa ku HMO?

Chokwera mtengo kwambiri ndi chiyani: HMO vs. PPO?

Nthawi zambiri, ma HMO amakhala ndi ndalama zochepa pamwezi kuposa ma PPO, koma kusiyana kwake sikofunikira nthawi zonse. Tebulo lotsatirali likuyerekeza kuyerekezera kwapadera kwapamwezi kwa mwezi ndi pachaka kwa inshuwaransi yaumoyo yomwe olemba anzawo ntchito amapatsa mu 2019, malinga ndi Kaiser Permanente Employer Health Care Kafukufuku wa 2019 .

	HMO	PPO
Umafunika pamwezi (wosakwatiwa)	$ 603	$ 640
Umafunika pamwezi (banja)	$ 1,725	$ 1,807
Umafunika pachaka (osakwatira)	$ 7,238	$ 7,675
Umafunika pachaka (banja)	$ 20,697	$ 21,683

Tchatichi chimachokera ku avareji yapadziko lonse ndipo sichiphatikizapo zomwe abwana anu amapereka. Kuchokera kwanu kwenikweni kungakhale kosiyana kwambiri ndi mtundu uliwonse wa mapulani. Dipatimenti Yanu Yothandizira Anthu imatha kukupatsirani ziwerengero kutengera mapulani omwe mwapatsidwa ndi zopereka za kampani.

Medicare onse ndi makampani ambiri ama inshuwaransi amapereka ma HMO ndi ma PPO onse. Ngati muwona wachipatala yemwe si wachikhalidwe, fufuzani kuti muwone ngati dongosololi likukhudzana ndi ntchitozi. Omwe samapereka chithandizo chamankhwala omwe amaphatikizapo ma chiropractor, ma acupuncturists, ma reflexologists, komanso othandizira kutikita minofu. Onaninso mosamala zochotseredwa ndikuwerengera ndalama zothandizira chisamaliro chaumoyo mchaka chimodzi kuti muthandize kudziwa zomwe zili zabwino kwa inu.

Wokonzeka kulembetsa?

Ngati mulibe inshuwaransi kudzera kwa abwana anu, mukufuna kuyambira chipatala.gov ndikuwona zomwe mungachite mdera lanu, akufotokoza a Matt Woodley, yemwe adayambitsa creditinformative.com . Pamenepo, mutha kufananiza zosankha, kuphatikiza ma HMO, ma PPO, ma EPO [Makampani Othandizira Okhaokha], ndi mapulani a POS [Point of Service]. Muyenera kuwunikiranso mwachidule mapindu a pulani iliyonse ndikuwongolera motsutsana ndi zosowa zanu komanso za banja lanu. Kwa iwo omwe ali ndi maukonde, mutha kutsimikizira kuti dokotala wanu wamkulu ali pamndandanda ndipo, ngati sichoncho, chotsani dongosololi ngati simukufuna kusintha madotolo.

Ziribe kanthu mtundu wamomwe mungasankhe, musanapereke mankhwala, onani SingleCare pamitengo yakomweko ndi coupon. Mukamagwiritsa ntchito SingleCare, mankhwala anu atha kukhala kutsika kuposa momwe mungalipire ndi inshuwaransi .