Florida State Health Insurance

Florida PPO Plans

What are PPO Plans?

PPO stands for Preferred Provider Organization. In the state of Florida, the PPO is a health insurance plan that
uses a network of healthcare providers who have made an agreement to provide medical services to a patient at a
discounted rate within the network. The PPO will usually be a separate entity from your health insurance carrier.

For you, as a customer, the major benefit of a PPO plan is the repricing of the bill. What this means is that you, as part of a PPO network plan, are entitled to the same discounts as the health insurance company receives from the PPO network. These discounts can be very substantial; a hospital bill of $100,000, for instance, can be lowered by almost 80% if you use a PPO plan. Regular doctor visits, on the other hand, usually get reduced by 30-50%.

When picking up a PPO plan, be sure to look at the clause that tells you about moving out of your PPO network. Most PPO plans will allow you to go out of the network. Your coinsurance and share of expenses, however, will be much higher than normal and there will be no repricing. Nevertheless, if you do go out of the PPO network, try and negotiate with the hospital; most hospitals will welcome it – they do want to get paid at the end of the day, after all.

Florida HMO Plans

What are HMO Plans?

HMO stands for Health Maintenance Organization.

It is a Florida health insurance plan type that depends on a primary care physician. Unless its a medical emergency or certain other special circumstances (which will be mentioned in the marketing literature of the insurance company), you will be required to consult your primary physician before you go to a hospital to receive care.

The HMO plan can be wonderful if you have a good physician who you’ve built up a strong relationship with. Moreover, under the Florida HMO health insurance plan, you usually pay lower deductibles than you would for a PPO plan. Your out of pocket expenses will also be lower for routine care with no hidden extras. You might also be eligible for maternity care in certain instances.

On the downside, the primary care physician must provide a referral before you can see a specialist. Also, you may not venture out of your network to seek care – thus, giving you zero flexibility.