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            California Health Care Insurance 101

            Everything You Always Wanted to Know About California PPOs, EPOs and HMOs

            When you’re looking for health insurance in California, it’s important that you understand the difference between PPOs, EPOs and HMOs.

            GotAffordableHealthInsurance.com offers a variety of insurance plans from a wide selection of providers. When you’re trying to decide what health insurance to buy, consider price, convenience and the coverage's provided.

            The best insurance policy for your needs has the right mix of all three components. Learn more about health insurance options in California, including PPOs, EPOs and HMOs before you decide which plan is right for you.

            California Health Insurance 101: Preferred Provider Organizations (PPOs)

            Preferred Provider Organizations (PPOs) offer the most flexibility and convenience of any health insurance plan in California.

            You receive prescription drug coverage, affordable doctor co-pays, and low deductible options with a PPO.

            In addition, if you need to see a specialist or want to see an out-of-network doctor or health care provider, PPOs don’t require referrals from in-network physicians.

            Even if you receive out of network health care, you are reimbursed for health care costs with California PPO health insurance.

            They provide the high quality health care with the most flexibility.

            California Health Insurance 101: Exclusive Provider Organizations (EPOs)

            Exclusive Provider Organizations’ (EPOs) health insurance plans in California have the same sort of flexibility and convenience as a PPO, but with some restrictions.

            You will still receive discounted prescription drugs, low deductibles and reasonably priced doctor co-pays with an EPO. However, if you have EPO health insurance in California and want to visit an out-of-network physician or health care provider, you will not be reimbursed. EPOs offer more flexibility than an HMO and price-wise, they tend to fall in between PPOs and HMOs.

            California Health Insurance 101: Health Maintenance Organizations (HMOs)

            Health Maintenance Organizations (HMOs) are only one of many types of managed care arrangements. However, it is one of the oldest forms of managed care. Some describe it as "pure" managed care. If the different types of managed care were placed along a continuum. Managed indemnity plans, which are very similar to conventional insurance, would be at one end. At the other end would be HMO's.

            As one moves toward the HMO end of the continuum, the organizations becomes more complex and have higher operating costs. However, more emphasis is placed on prevention and quality of care. There is also more opportunity to control health care costs in HMOs than in indemnity plans.

            Individuals who join an HMO are considered members. Typically HMOs provide members with comprehensive health care.

            When someone joins an HMO, they select a primary care physician from the list provided by the HMO. That primary care physician coordinates all of that member's medical care.

            If care by a specialist is needed, the primary care physician will refer the member to a specialist who is usually also in the HMO network. In an HMO, physicians may be employees of the HMO or the HMO may contract with independent physicians to provide care.

            Members who go outside of the network to receive care (unless given prior approval) will probably pay all or most of the cost of that care out of their own pockets.

            HMOs use a "capitated" financing system. Care is provided to each member of the plan for a fixed amount. Typically, an employer contracts with an HMO to provide care for its employees and pays this fixed charge.

            If you are part of a Medicare HMO, than Medicare pays the fee. Some HMOs also charge individuals a small co-payment for each visit.

            If the HMO is efficient and keeps its members healthy, it will make a profit. If it has too many members who require costly sick care, its profits are smaller or it may lose money.

            Remember under a "capitated system", the HMO is paid a fixed amount per person rather than for each visit or by type of service.

            California Health Insurance 101: Compare Affordable PPOs, EPOs and HMOs

            Compare prices for affordable health insurance from PPOs, EPOs and HMOs in California at gotaffordablehealthinsurance.com.

            Even if you already have health insurance, you can get a no-obligation quote online today to see if we can save you money on your insurance premiums.

            For more information, contact us at 323-937-5690 or send us an email with your questions about finding the right California PPO, EPO or HMO health insurance policy for your unique needs.

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            GAHI provides health care insurance coverage for individuals, families and temporary insurance needs, self-employed individuals and at-risk, catastrophic situations for all Northern and Southern California cities and regions.