Monthly Archives: October 2025

HMO vs. PPO: What’s the Difference?

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by Natalie Stefan

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HMOs, PPOs, EPOs… oh my! With so many types of health insurance plans out there, it’s easy to feel overwhelmed. Understanding what each plan offers, and the potential drawbacks, can help you make a confident, informed decision about your health coverage.

With open enrollment just around the corner, now’s the perfect time to review your options. To make things easier, we’ve broken down the most common plan types with a quick list of pros and cons.

HMO (Health Maintenance Organization)

Pros:

  • Lower out-of-pocket costs when you stay in-network
  • Simplified care coordination through your primary care physician (PCP)

Cons:

  • You’ll need a referral from your PCP to see most specialists
  • Coverage is limited to in-network providers

PPO (Preferred Provider Organization)

Pros:

  • Flexibility to see specialists without a referral
  • Out-of-network coverage available (though at a higher cost)

Cons:

  • Generally higher premiums and out-of-pocket costs

POS (Point of Service)

Pros:

  • Option to see out-of-network providers
  • Lower costs when you stay in-network

Cons:

  • Often requires a referral from your primary care physician to see a specialist

EPO (Exclusive Provider Organization)

Pros:

  • No referrals needed to see specialists
  • Lower premiums compared to PPO plans

Cons:

  • No coverage outside your plan’s network (except in emergencies)

Finding the right health insurance plan can feel like a challenge, but you don’t have to navigate it alone. Health Plans of America connects you with licensed insurance professionals who can help you compare options, find savings, and get answers to all your health coverage questions.

Whether you’re exploring new plans, renewing your coverage, or just looking for expert advice, Health Plans of America is here to help you make the right choice.

Tips for Choosing the Right Medicare Plan

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by Natalie Stefan

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Navigating Medicare can feel overwhelming at first — but it doesn’t have to be. The key is to start with what matters most to you: your health needs, prescription medications, how often you see your doctor, and your long-term health goals.

Ask yourself: Does my current Medicare plan truly support the lifestyle I want?

Health Plans of America offers helpful resources and guidance so you can make confident, informed decisions. Below is a quick guide to important factors to consider before enrolling in or changing your Medicare plan:

1. Look for Extra Benefits That Match Your Health Goals

Original Medicare (Parts A and B) covers hospital and medical services, but it doesn’t include vision, dental, or hearing care. If these are important to you, consider a Medicare Advantage plan — many offer these additional benefits. Keep in mind that costs and coverage can vary since Advantage plans are provided through private insurers.

Alternatively, Medicare Supplement (Medigap) plans may help cover out-of-pocket costs or offer add-on benefits if your current plan doesn’t include what you need.

2. Make Sure You Can See the Doctors You Prefer

If keeping your current doctors and specialists is a priority, pay close attention to each plan’s provider network. Some Medicare Advantage plans require you to use in-network providers, while others offer more flexibility. Always verify that your preferred doctors are covered before you enroll.

3. Consider Your Travel Plans

Do you spend part of the year outside the U.S. or travel frequently abroad? In that case, supplemental coverage may be the right choice. Original Medicare generally doesn’t cover medical care outside the country, so it’s important to confirm with your plan representative what your options are before traveling.

4. Don’t Overlook Prescription Drug Coverage

Even if you don’t currently take prescription medications, it’s wise to plan ahead. Health needs can change unexpectedly, and having Medicare Part D or prescription coverage through an Advantage plan ensures you’re protected from high out-of-pocket medication costs in the future.

Ready to Find the Right Plan for You?

Now is the perfect time to explore your options. Fill out a form and get connected with a licensed insurance agent to get personalized guidance. They’ll connect you with a licensed insurance agent who can help you compare plans and find one that fits your needs and budget.

Take the first step today — your future health and peace of mind are worth it.