A Health Maintenance Organization (HMO) is a type of managed care health plan where members choose their physician from a list of approved health care providers. Members of an HMO can only see a health care specialist if they get a referral from their primary care physician, also known as a gatekeeper. Your primary care physician serves as your health care advocate and will help you find the best treatment for physical and mental health problems you might face. With a HMO your choice of physicians is more limited. Unless it is an emergency all care must be through the HMO.
A PPO does not require the use of a primary care physician (PCP) or a referral to see a specialist. You can keep your out-of-pocket spending, lower by using network providers.
Plan members can receive care from providers outside of the network at a higher cost.
Short term medical (STM) insurance provides temporary benefits up to 90 days in many states. STM is designed to provide financial protection in the event of an unexpected injury or illness, while waiting for coverage to begin under an ACA-qualified plan.
Covered California is the state exchange and is the only way, if you qualify, to receive a cost lowering advance premium tax credit. Plans are available in all four benefit tiers Bronze, Silver, Gold, and Platinum. You have a choice of HMO, PPO, or EPO plans through the exchange. Family income must meet Federal guidelines in order to receive a premium tax credit and detailed financial and tax information is required.
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