Explore Provider Networks: HMO, PPO, and EPO
Health Maintenance Organization (HMO) plans offer a focused network of doctors and hospitals. You choose a primary care provider (PCP) who manages your care and provides referrals to specialists within the network. HMOs feature lower out-of-pocket costs and require referrals for specialists.
Preferred Provider Organization (PPO) plans offer flexibility to see any doctor or specialist. You don't need a PCP and can self-refer to specialists. While in-network visits usually have lower costs, PPOs provide some coverage for out-of-network care, though costs may be higher.
Exclusive Provider Organization (EPO) plans strike a balance by offering in-network coverage only, similar to HMOs, but without requiring a PCP or referrals for specialists. With EPOs, you gain predictable costs for in-network care, so it's essential to stay within the network to maximize your benefits.
Understanding Covered California and Financial Help
What is Covered California?
Covered California serves as the state's health insurance marketplace, presenting a range of health plans divided into four tiers, each with varying monthly premiums and out-of-pocket costs for services. It was established under the Affordable Care Act to provide a place where individuals can get financial help to lower costs for health coverage and care.
How Does Financial Help Work?
Qualified individuals can get financial help in the form of premium subsidies and tax credits to lower their monthly premiums and pay less for out-of-pocket healthcare costs like copays, coinsurance, and deductibles.