HMO vs. PPO: Kuziva mutsauko muzvirongwa zvekuchengetedza hutano

Kambani

Kusarudza iyo chaiyo inishuwarenzi yehutano chirongwa chako iwe nemhuri yako ibasa rinotyisa. Nemutengo unokwira wekuchengetwa kwehutano, zvinogona kunetsa kuyera kutsvaga chirongwa chinodhura uye chirongwa chinopa rubatsiro rwakanakisa. Nhanho yekutanga yekusarudza kunzwisisa mashandiro anoita chirongwa chimwe nechimwe. Muchikamu chino, isu tinofananidza maviri akakurumbira marudzi ezvirongwa-HMO vs. PPO- uye tarisa maficha eimwe neumwe.

Chii chinonzi HMO?

AnHMO, iyo ipfupi kune Health Maintenance Organisation, imhando yehurongwa hwehutano iyo inowanzo shandisa varapi vekutanga ekurapa (PCPs) kubatsira kubatsira kuronga kwevarwere. Ivo vanoshandisa network yevanachiremba, zvipatara, uye vamwe vanopa hutano. Paunosarudza chirongwa cheHMO, unotora PCP kubva kunetiweki yavo. Yako PCP inowanzo kurongedza ako anodikanwa ekurapwa masevhisi, ichipa kuendeswa kune bvunzo uye netiweki nyanzvi kushanya, uye kazhinji kugamuchira mishumo uye mhedzisiro yekuyedzwa. Ivo havawanzo kufukidza kunze-kwe-network kutarisirwa, kunze kwekukurumidza.

Chii chinonzi PPO?

PPO, iyo inomirira Preferred Provider Organisation, imhando yehurongwa hwehutano hune zvakare netiweki yavanachiremba, zvipatara, nevamwe vanopa hutano; zvisinei, ivo vanopa kuwedzera kuchinjika pavanotsvaga kutarisirwa. Ivo vanobhadhara kuchengetwa kwevamwe vekunze-kwe-network hutano hwekubatsira, asi ivo vanowanzozviita pamutero wakaderera uye munhu ane inishuwarenzi anogona kuve anotarisira chikamu chemutengo wese. Iwe hauwanzo kuda kuendeswa kuti uone nyanzvi.

HMO vs. PPO: Ndeupi musiyano?

Pamusoro peiyo in-network uye kunze-kwe-network misiyano inosanganisirwa neHMOs uye maPPO, kune akasiyana maficha ane hukama nemakambani einishuwarenzi ehutano. Izvi zvinotevera zvinoenzanisa zvimwe zvinhu.

PPOs dzine hombe network dzevanopa

Ose maHMO nePPOs ane network yevanachiremba, zvipatara, nevamwe vanopa hutano. Mari yako yekunze-yehomwe ishoma kana iwe ukashandisa vanopa zvekurapa mune ino network.

HMOs zvinowanzoda kuti iwe usarudze wekutanga wekutarisira kubva kune dhairekitori dhairekitori. Izvi kazhinji zvinowanzova kukanganisa kukuru kune chirongwa - kuti iwe unowanzo kuverengerwa kuhuwandu hwevanopa. Pamusoro pezvo, iwe unowanzo fanirwa kuona PCP usati waona nyanzvi. Imwe chete inosarudzika kune zvido zvekutumira ndeye gynecologic / obstetric kutarisirwa. Iwe haudi kuendeswa kuti uone varapi ava, asi ivo vachiri vanofanirwa kuve mukati memupi wako network.

PPO zvirongwa zvine zvirambidzo zvishoma pane yavo network yevanopa. Iwe une mukana wekuchinjika, uye maPCO network anowanzo kuve makuru kupfuura maHMO. Vazhinji havadi kuti iwe usarudze wekutanga chiremba chiremba paunosaina kuchirongwa, uye ivo vanobhadhara vamwe kunze-kwe-network kutarisirwa , kazhinji ine yakakwira copay kana yemari yekusimbiswa. Iko kune kazhinji mupi wevapi, uye tier 1 iri yako in-network vanopa, tier 2 inobhadharwa pamutengo wakaderera (uye nemari yepamusoro yevatengi), uye tier 3 inobhadharwa pamutengo wakaderera (uye nemutengo wepamusoro wevatengi).

HMOs ine yakaderera kunze-kwe-muhomwe mari

Paunenge uchisarudzira mutengo wako wese weinishuwarenzi yehutano, unofanirwa kuisa kunze-kwehomwe mari. Izvi zvinosanganisira maprimiyamu, anobvisirwa mari, koresheni uye macompayments.

Premium

TO shoma imari yakatarwa iwe yaunobhadhara pamwedzi kuti uve neinishuwarenzi yehutano zvisinei kuti unoishandisa mwedzi iwoyo. Zvirongwa zvepasi pekutanga kazhinji zvine zvakaderedzwa zvakanyanya uye zvinopesana. Kana iwe uine inishuwarenzi yehutano kuburikidza newaunoshandira, mari iyi ingangobviswa pamubhadharo wako uye ikabhadharwa kune anopa inishuwarenzi.

HMOs dzinowanzove nemari yepasi shoma pane PPOs asi mutsauko ungasave wakakosha.

Inobviswa

Zvegore zvakabviswa imarii yaunoda kushandisa kubva muhomwe pane yakavharirwa mari yehutano pamberi pekambani yeinishuwarenzi isati yabhadhara zvikwereti. Iwe unogona kuve nezvakaparadzaniswa zvakaparadzaniswa zvechikamu chekurapa uye chikamu chemushonga chehurongwa hwako. Zvinobvisirwa zvinogona kuve pachikamu chimwe chete chehurongwa- senge kuchipatara kana kunyorerwa - izvo zvinofanirwa kugutswa vasati vabhadhara chero chikumbiro.

HMOs inowanzove yakaderedzwa yakaderera pane mamwe marudzi ezvirongwa, kusanganisira maPPO. Dzimwe HMOs hadzina chero maratidziro.

Coinsurance

Coinsurance chikamu chemari yekurapwa yaunosungirwa kubhadhara mushure mekusangana neyako yakadhonzwa. Semuenzaniso, kana iwe uine 20% yemari yekusimbiswa uye unogashira chiremba dhiri remadhora chiuru, uri mutoro wemadhora mazana maviri, uye kambani yeinishuwarenzi ichabhadhara zvimwe.

HMOs kazhinji haina mari yekusimbiswa.

Copay

Kukopa, kana kukopa , imari yakatarwa yemari yaunobhadhara paunoona chiremba kana kuwana mushonga; inowanzosiyana zvichienderana nebasa rezvehutano. Semuenzaniso, paunoshanyira chiremba wako wekutanga, copay yako inogona kunge iri $ 20; $ 40 kune nyanzvi; kana madhora mazana maviri nemazana mashanu ekushanyira imba yekukurumidzira. Mapepa ekunyora mapepa anowanzo kuverengerwa zvichibva pane zvakajairwa nemazita ezita zvinodhaka.

HMOs dzinowanzoda macopay ekuchengetedzwa kusingadziviriri uye maPPO anoda macopay kune mazhinji masevhisi. Ongorora: Copays haishandiswe kune iyo yegore inobviswa.

Kunze kwehomwe kunonyanyisa

Pamusoro pezvo, iwe unofanirwa kuziva nezvechirongwa kunze-kwehomwe kunonyanyisa . Kana iwe ukasvika pamari iyi mugore rimwe chete, kambani yeinishuwarenzi inobhadhara masevhisi ako akafukidzwa pa100% kune yakasara yegore rekarenda.

Zvirongwa zvese zvemusika zvine miganhu yekubuda muhomwe. Zve 2020 , iyo yekunze-kwehomwe muganho ndeye $ 8,150 kune vanhu uye $ 16,300 yemhuri.

Kudzokorora: HMO vs. PPO
	HMO	PPO
Mutengo	Maprimiyamu anoenderana nezvinhu zvakasiyana, senge kwaunogara, zera rako, uye kana uine chirongwa chemhuri. Muzhinji, maprimiyamu eHMO akaderera pane mamwe marongero (akaita sePPOs) ayo anokupa iwe kuchinjika. Uyezve, iwe unogona kubhadhara zvishoma kune zvakabviswa, macopay, uye zvirevo nemaHMOs.	PPO maprimiyamu akakwirira kupfuura maHMO. Iwe zvakare unowanzo bhadharira yakawanda kunze-kwe-muhomwe kudhura senge zvinokamurwa uye copays.
Network	Iwe unofanirwa kugara mukati mevanopa network kune mari yekuchengetedza.	Iwe une mukana wekubuda-kwe-network uye uchiri kuwana mamwe marapirwo ehutano akafukidzwa.
Zvinyorwa	Iwe unozoda kuendeswa kuti uone chero chero chiremba chero asiri wako wekutanga chiremba chiremba.	Iwe haudi kuendeswa kune vamwe vanachiremba / nyanzvi.

Zvino Nani Kupfuura PPO HMO?

Zvichienderana nekuchinjika muPPOs, vanhu vazhinji vanosarudza iyi mhando yehurongwa. Makumi mana nemana muzana evashandi vakanyoreswa muPPO, uye 19% vakanyoresa muHMO, sekureva kwe 2019 Yevashandi Hutano Ongororo . Asi mubvunzo urinani ndewokuti, nderupi rwurongwa rwakanyanya kundinakira? Ose maPPO uye maHMO ane zvazvakanakira nekuipira. Iyo iyo yakakunakira iwe zvinoenderana newe uye zvemhuri yako zvehutano zvinodiwa.

Kazhinji, HMO inogona kuve nemusoro kana yakaderera mitengo yakanyanya kukosha uye iwe usine hanya nekushandisa PCP kubata kwako kutarisira. Nekudaro, iwe unofanirwa kuongorora marongero enetiweki masevhisi kutanga, sezvo mamwe anogona kunge akaganhurirwa. PPO inogona kunge iri nani kana iwe uchitova nachiremba kana timu yekurapa iyo iwe yaunoda kuchengeta asi isiri yako yehurongwa network.

Mibvunzo yekubvunza kana uchifunga nezvehurongwa hweHMO inosanganisira:

• Varapi vangu vari muHMO network? Kana zvisiri, ndakagadzirira kuchinja vanopa?
• Ndeupi mutengo wepamwedzi wepuramu?
• Ndeapi macopay anodhura?
• Kangani ini nemhuri yangu tichienda kwachiremba? Mugore chairo, ndezvipi zvandingashandisa?
• Pane chero munhu mumhuri yangu ane hutano hwakakomba kana anoda kurapwa kwakanyanya?
• Ndiri kuda here kuendeswa kana ini ndikaona wekurapa kunze kwePCP yangu?

Mibvunzo yekubvunza kana uchifunga chirongwa chePPO inosanganisira:

• Varapi vangu varimo muurongwa network? Kana zvisiri, ini ndakagadzirira here kubhadhara yakakwira koresheni?
• Iko kune here kunobvisirwa kwekunze-kwe-network chengetedzo?
• Ndeupi mutengo wepamwedzi wepuramu?
• Chii chingashanyirwa nachiremba chaiye, zvichibva pamari yekusimbiswa?
• Ndinogona here kufungidzira yangu yegore rose kunze-kwehomwe mari?
• Pane mumwe here mumhuri yangu ane chirwere chinoshumirwa zvakanyanya nevanoona nezvekurapa kunze kweChikamu 1 kana kuti isu tisingakwanise kuona kana isu takanyoreswa muHMO?

Chii chinodhura zvakanyanya: HMO vs. PPO?

Kazhinji, maHMO ane maprimiyamu akaderera emwedzi pane maPSO, asi mutsauko haugare uchikosha. Iyi tafura inotevera inopa kuenzanisa kweavhareji pamwedzi uye epagore maprimiyamu evashandirwi-akapa inishuwarenzi yehutano muna 2019, sekureva kwe Kaiser Permanente Mushandirwi Hutano Kuchengetedza Ongororo ye2019 .

	HMO	PPO
Mwedzi wega wega (wega)	$ 603	$ 640
Mwedzi wepuraimari (mhuri)	$ 1,725	$ 1,807
Mutengo wepagore (wega)	$ 7,238	$ 7,675
Mari yepagore (yemhuri)	$ 20,697	$ 21,683

Iyo chati yakavakirwa paavhareji yepasirese uye haina kusanganisira zvinopihwa neako mushandirwi. Kubviswa kwako chaiko kwemubhadharo kunogona kuve kwakasiyana zvakanyanya kune yega yega mhando yehurongwa. Dhipatimendi rako reHuman Resources rinogona kukupa iwe manhamba zvichienderana nezvirongwa zvakapihwa uye mipiro yekambani.

Ose maviri maMedicare uye mazhinji makambani einishuwarenzi anopa ese maHMO nemaPPO. Kana iwe ukaona asiri-echinyakare mupi wezvekurapa, tarisa kuti uone kana chirongwa ichi chichifukidza aya masevhisi. Vasiri-vechinyakare vanopa vekurapa vanosanganisira chiropractors, acupuncturists, reflexologists, uye masaja varapi. Tarisa zvakanyatso kubviswa uye uverenge mari yekuchengetedza hutano mukati megore chairo kuti ubatsire kuona kuti ndezvipi zvakakunakira iwe.

Wagadzirira kunyoresa?

Kana iwe usina inishuwarenzi kuburikidza newaunoshandira, unoda kutanga pa zvehutano.gov uye uone kuti ndeapi sarudzo aripo munharaunda mako, anotsanangura Matt Woodley, muvambi we creditinformative.com . Ikoko, iwe unogona kuenzanisa sarudzo, kusanganisira HMOs, PPOs, EPOs [Exclusive Provider Organisations], uye POS [Point of Service] zvirongwa. Iwe unofanirwa kuongorora pfupiso yemabhenefiti kune yega yega hurongwa uye muchinjiko-revhisi inopesana neyako neye yako yemhuri zvinodiwa zvekurapa. Kune avo vane netiweki, unogona kuona kuti chiremba wako wekutanga aripo pachinyorwa uye, kana zvisiri, bvisa chirongwa icho kana iwe usiri kuda kuchinja vanachiremba.

Hazvina mhosva kuti nderipi zano raunosarudza, usati wabhadharira tsamba, tarisa SingleCare yemitengo yemuno uye koponi. Paunoshandisa SingleCare, mishonga yako inogona kunge iri yakaderera pane yaungabhadhara neinishuwarenzi .