Choosing a Health Insurance NY Plan

The law prohibits the sale of health insurance across state lines, so if you live in New York State, you must purchase a health insurance NY plan. There are a variety of different types of insurance plans available within the state, and it is important to understand the types of plans available so you can make an informed choice about what is right for you.

HMO vs. PPO Insurance Plans

When you are purchasing a health insurance NY plan, you generally have two choices: an HMO or a PPO. While another type of plan called a "major medical plan" or catastrophic plan exists in some states, such plans are generally not available in New York unless you qualify for a lower income plan subsidized through the government called Healthy NY. Of your options, an HMO and a PPO work in different ways and offer different advantages and disadvantages.

HMO Plans

HMO stands for "Health Maintenance Organization," and it works as you might expect from the plan's name: your care is managed by your health insurer to a certain extent. There are a few basic requirements for those who are insured through an HMO:

• When you obtain insurance through an HMO, you typically must choose a primary care physician from a network of providers.


• You will need to visit your primary care physician in order to obtain advanced authorization and referrals to specialists if you need care that a general practitioner cannot provide.


• You will also be restricted to seeing providers in network who agree to the terms and payment structure required by the HMO.

PPO Plans

PPO, on the other hand, stands for Preferred Provider Organization.

• A PPO plan also provides a network of care providers, but when you are insured through a PPO, you typically may visit any doctor within the network without a referral from a primary care physician.


• In addition, you have the option of also choosing doctors or specialists outside of the PPO network, although you will have to incur more out-of-pocket costs.

Advantages and Disadvantages of HMO and PPO Plans

Both HMO and PPO plans offer different benefits and disadvantages. Some advantages of each include:

• HMO's may be less expensive than PPO plans, although this is not always the case and is dependent upon the co-pay and other features of your plan.


• When you use an HMO plan, your medical records are typically maintained by the HMO and are accessible to all providers within the network, insuring ready access to information.


• Billing in an HMO is straightforward and it is generally clear exactly what your benefits are and what you will pay for services.


• A PPO, on the other hand, provides you with a greater choice as far as providers and typically has a broader geographic reach than an HMO network.

Some disadvantages of HMOs and PPOs include:

• HMO plans may be restrictive due to the reliance on a primary care physician and a referral requirement. They may also have physicians only in a limited area.


• PPO plans may not provide centralized medical records, making information more difficult to obtain.


• PPO plans have more uncertainty in out of pocket costs.

When choosing a health insurance NY plan, the benefits of each type of plan should be carefully considered. An experienced insurance agent can help you to make an informed choice as to what is best for your family.