HMO vs PPO vs HSA: What Do They Mean?

Health insurance terminology can confuse first-time policyholders and people changing their insurance coverage. A few of the more confusing acronyms are HMO, PPO and HSA. What do they mean, and how do they affect your care options?

What is an HMO?

HMO stands for “Health Maintenance Organization.” With an HMO, you have access to a network of hospitals, doctors and other healthcare facilities.

HMOs are set up to keep costs in check for policyholders. However, while HMOs have lower costs, your options are more limited.

Here are some important things to know about HMOs:

• Healthcare providers in the HMO’s network have agreed to accept payment at a specific level for the services they provide. This agreement keeps premiums, coinsurance and copays lower than other types of insurance.

• Although payments are lower, out-of-network care is not covered by an HMO except for in cases of true emergencies.

• Provider options are more limited than other insurance options because the provider must be within the HMO’s network.

• With an HMO, you must choose a primary care physician from their network, and this doctor will be the person you see whenever you require medical care. If you need to see a specialist, you will first need to see your primary care physician to get a referral.

With HMOs, your options are limited. However, the out-of-pocket cost of care is generally lower. In addition, many HMOs have more than adequate options for physicians and specialists. For those only requiring basic medical care, a yearly checkup and immunizations, an HMO may be a good option.

What is a PPO?

PPO stands for “Preferred Provider Organization.” A PPO also has a network of healthcare providers who agree to provide policyholders with care. While PPOs have a network, you aren’t necessarily obligated to use it.

Here are some important things to know about PPOs:

• With a PPO, you can receive care from any provider, whether they are in your network or not. Having this flexibility means that you can receive care at any hospital, doctor’s office or specialist.

• PPOs do not require you to choose a primary care provider, and you do not need a referral to see a specialist.

• Greater flexibility comes at a higher cost. PPOs generally cost more than HMOs and other types of health insurance. Premiums are typically higher as well as copays. Additionally, an annual deductible must be met.

• Using providers within the PPO network can help save on costs.

If you want more control over your choice of providers or travel often, a PPO may be a good fit.

What is an HSA?

HSA stands for “Health Savings Account.” HSAs are different from HMOs and PPOs because they aren’t really a type of health insurance. Rather, they are a special type of savings account that allows you to save and pay for the cost of healthcare in the future using pre-tax income.

HSAs can be used to cover qualified medical expenses, but there are some stipulations:

• You can only contribute to your account if you have a High Deductible Health Plan, or HDHP. These plans generally only cover preventative services before a deductible.

• If you have a qualifying plan in 2022, you can contribute up to $3,650 for a single individual or $7,300 for a family.

• Funds in your HSA roll over to the next year if they aren’t used.

• HSAs can also earn interest and other earnings that are not taxable.

Now that you have a better understanding of the difference between an HMO, PPO and HSA, you can determine which type of coverage is best for your needs and budget.


What Is The Best Hmo Insurance In Ohio?

The cost of the insurance is dependent on the age of the applicant and the level of coverage, thus elderly people have a much higher price. 

Stats regarding the insurance plans show us that a citizen of 60 years pays 112% more for health insurance than a citizen aged 40 and that is not changed with the level of insurance you chose for yourself and your family.  A 40-year-old, however, pays 28% more premium than the ones paid by the 21-year-old. 

We have discussed the best HMO insurance in OHIO in this article. The plans might not be offered throughout the county but the below-mentioned plans are worth looking into.

Best insurance deals in Ohio 

The insurance policies available to you highly depend on where you live. You are sure to get various options to choose from for the level of coverage that you can take in every county. The best cheap health plan, will bases on a portion of your income, and the expected medical costs as they affect the price you will pay, and the level of coverage you may need. 

Higher levels of coverage may be more expensive in terms of insurance premiums, but their lower cost makes them a great option for families who are expecting large or subsequent health care costs. 

On the other hand, low-coverage health plans have lower fees but high out-of-pocket costs incurred, meaning that they are only suitable if you have some extra savings, and are expected to not have to require expensive medical care


Gold Plan: Best for families, with a high fixed medical cost 

If you expect high medical costs then the gold plan is the best option for you. In the

Gold plan, you will be charged a monthly cost but will have the lowest out-of-pocket costs.

Ultimately the cost you have to pay is lower than what your insurance has to pay. This is a great advantage for individuals who are expected to have large medical expenses and are unable to pay them out of pocket. 


Silver Plans: Best fit for low-income households and the average medical cost

Ohio expanded Medicare under the Affordable Care Act, which means that if the family income was up to 138% of the federal poverty level then they may qualify for Medicaid. Low-income families who do not qualify, have chances to get a better price with the Silver plan. 

Silver health insurance companies are the only ones who will be eligible for a reduction of the cost of subsidies, as the family’s income is below a certain threshold. Silver plans are a good solution, because you’ll get more affordable health insurance rates than a Gold plan, and less out-of-pocket expenses, then you have to deal with a bronze plan. 


Bronze/Bold plans: Best Fit for families with young children, with the highest cost-sharing

If you’re under the age of 30, or you are eligible for several exceptions, you can sign up for a bronze health insurance plan. Bronze Plans offer the lowest monthly cost and the highest cost-sharing. 

We do not recommend acquiring any Bronze Plan anywhere in Ohio until you are confident that you will be able to pay high out-of-pocket costs in case you need medical care. Your insurance will not cover it until you pay out-of-pocket expenses and your share. 

For example at the Ambetter Essential Care 1 (Bronze premium plan, the cost can be as low as $ 242 a month for a 40-year-old, which is a lot cheaper than the $368 bonus for the Ambetter Secure Care 5. The deductible for a Bronze Plan, however, is nearly $ 7,000 more expensive than the Gold plan. 


Changing Insurance Rates in Ohio 

Insurance rates, deductibles, and maximum out-of-pocket amount to be determined annually by health care companies, then to be submitted to federal regulators for approval. 

Stats tell that the overall costs of insurance are reduced by 4% in all of the plans in 2021. The price of bronze’s plans was dropped by the biggest amount: 7%, or $26 per month.


The Short-Term Health Insurance in Ohio 

If you are living in Ohio then you might also be able to acquire the opportunity to purchase short-term health insurance plans. The insurance coverage is for a maximum of 12 months, as in the federal rules and regulations. However, Ohio does not allow the insured person to renew the short-term health insurance policy at the end of the original period of insurance. 

You might want to take a brief medical policy, if you miss the open enrollment period, you will lose the employer-sponsored health care system. It is important to keep in mind that short-term plans do not provide the same essential benefits as a Private medical insurance policy 


The best HMO Insurance Companies in Ohio 

Currently, there are 10 health insurance companies listed in Ohio, two more than the previous year. However, all these companies do not provide all the services in all the counties. Following are the best HMO insurance in Ohio.

  • Community Insurance Company (Anthem Blue Cross Blue Shield 
  • Car CareSource Insurance
  • Buckeye Ambetter Buckeye Community Health Plan 
  • Medical Health Insuring Corporation. Ohio оскар
  • Oscar Insurance Corporation (Ohio) 
  • Molina Healthcare of Ohio, Inc. 
  • AultCare insurance company for you 
  • Paramount Insurance company First 
  • The Oscar Buckeye State Insurance Corporation. 
  • First Insurance Company, Inc. 

Depending on where you live, you can choose from up to 5 insurance providers, although a lot of counties have only one insurer available. For example, if you live in Columbus, Franklin County, you can compare the plans of the six insurance companies, rather than the 10 that will be available for the entire state. 


Cheapest health insurance in the districts 

To assist you in your quest to find the best health insurance plan, we compared all of the silver plans, in Ohio, and identified them to be the cheapest plan offered in each electoral district. The Ambetter Balanced Care 2 health plan is the most cost-effective in 58% of counties in Ohio.