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Health Maintenance Organizations
HMOs give you a list of doctors from which to choose a primary care physician (PCP). A PCP coordinates your care, which means that generally you must contact him or her to be referred to a specialist within your designated medical group. If you belong to an HMO, the plan only covers the cost of charges for services authorized by your PCP. HMOS only provide coverage for services outside of your medical group in cases of emergencies.
For Medicare enrollees:
Point-of-Service Plan*
This plan combines characteristics of the HMO and the PPO. The in-network level of this plan functions like an HMO and you must choose a primary care physician who is responsible for all referrals within the POS network. If you choose to go outside the network for healthcare, the plan functions more like a PPO.
Anthem Blue Cross PLUS
Preferred Provider Organization (PPO)*
A PPO generally offers a broader network of doctors and hospitals than an HMO. This plan model has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the plan for their services and participate in the network of physicians. If you need or want heath care from outside the network you have access, but you should expect to pay a higher copayment than if the provider were from within the PPO network.
Anthem Blue Cross PPO
Fee-for-Service Plan*
This plan allows you to choose the doctor, the hospital, the clinic, or the behavioral health provider and the insurance pays for part or all of the cost according to the schedule laid out in the policy after you have met your plan's deductible. Under this plan, you pay for services up front and submit a claim to the insurance company, and if the service is covered in the policy, you receive reimbursement.
Core
For Medicare Enrollees: High Option, Core
To learn more about the similarities and differences among HMOS, Point of Service plans, PPOs and fee-for-service plans, see the Medical Plan Comparison chart.
To compare medical plans use the Medical Plan Chooser.
*Available to retirees living outside of California
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