What is an HMO?
It means Health Maintenance Organization because it only covers services from a designated organization of doctors, specialists, and hospitals. This type of insurance plan gives you a primary care physician (PCP) who refers you to specialists that accept HMO insurance. HMOs are typically cheaper than PPOs.
What is a PPO?
It means Preferred Provider Organization because you may visit doctors and specialists in your insurance plan's "preferred network" without referrals from a PCP. A PPO prefers to cover services in a PPO network, but if you visit a doctor who doesn't accept PPO insurance, your insurance may pay for some or none of it. This plan gives you more flexibility but usually has higher premiums.
What is a Primary Care Physician (PCP)?
Under an HMO, you're assigned a Primary Care Physician, who is your go-to doctor. If you want to visit a specialist, your PCP must write a referral. In emergencies or for an OBGYN, you don't need a PCP referral.
What is a referral?
This is a recommendation from your PCP to visit specialists within the HMO network, such as: dermatologists, urologists, proctologists, etc.
What is a copay?
It's the amount you pay for a doctor's visit or prescription. Preventive care services: screenings, vaccines, blood tests, birth control, and annual check-ups are free.
What is a premium?
It's the amount you pay each month to keep your insurance plan. The amount you pay for your premium does not count toward your deductible or out-of-pocket limit.
What is a deductible?
It's the amount of money you pay before the insurance company pays for its share. If your deductible is $500, you're responsible for paying $500 of whatever health service. After you pay your deductible, your insurance company will cover a percentage of the rest of the bill, depending on the plan's "metal tier":
What is out-of-pocket?
It's what you pay for health services (including your deductible) until you reach your out-of-pocket limit (sometimes called "maximum"). After you reach your out-of-pocket limit, your insurance company covers all expenses for the rest of the year.
What is Covered California?
What's in My Insurance Plan?
What are Subsidies (Tax Credits)?
What is the Affordable Care Act?
Frequently Asked Questions
Click here for a Quick Guide to Covered California.
As Covered California certified agents, it's our mission to educate the public so you have peace of mind when selecting affordable health insurance. Please enjoy the following videos to answer everything you need to know about coverage, brought to you by Covered California.