Is Cigna insurance a PPO or HMO?Posted by On


Were it not mandatory, we’d all still need health insurance. However, that doesn’t mean that the same plan or coverage will fulfill our needs. They are unique. Therefore, we need a program that will translate into a better experience.

For instance, for some of us, the carryover of the deductible from the fourth-quarter is essential. Others may think of emergency room care as more of a priority.

With our help, you can figure out which of the plans, PPO or HMO, will provide you with peace of mind. After all, no one likes receiving surprise medical bills from contact with the health care system.

Before we can answer whether freedom life health insurance Cigna is HMO or not, you’d need to know what the term refers to:

What are HMOs?

Short for Health Maintenance Organization, an HMO is a term for a network of healthcare providers. Some examples include general physicians and specialists, such as dermatologists and chiropractors.

The insurance company responsible for your coverage negotiates the prices those doctors will provide. Most of the time, those prices are lower than those you’d find elsewhere.

When you sign for one, you get a list with the names of those healthcare providers. You pick one for yourself. That professional will be your gatekeeper or Primary Care Physician (PCP).

Should you need a specialist for some reason, like an obstetrician, cardiologist, or rheumatologist, you’ll need your PCP’s referral to see one. You won’t have to get it during an emergency. Neither would you require one for visits to a gynecologist or obstetrician, provided they are in-network.

What is a PPO?

A Preferred Provider Organization also has a network of healthcare providers, like doctors and hospitals. The latter, too, negotiate that they will provide you care at a specific rate. However, with a PPO, you aren’t limited to seeking out in-network healthcare providers.

You can see other professionals, but you may have to do it through copay or cover the out-of-pocket cost yourself. Moreover, in both cases, you won’t be paying the lower post-negotiation prices.

Additionally, you’ll also get more options when choosing lab service providers with PPO plans. Thus, you may pick one conveniently located close to you.

Cigna insurance, now, offers both PPO and HMO plans. We’ll discuss the salient differences between them to make selection easier – and more accurate – for you:

Provider networks

Unlike in an HMO plan where you must visit your PCP and maintain one all year-long, you don’t have to do that.

Moreover, if you stay within your network in an HMO plan, you get maximum insurance coverage. That coverage vanishes when you go outside of the system.

With a PPO, visiting doctors outside the system would still get you some coverage – even if it isn’t as much as you would get for in-network providers.

Affordability and ease of access

Sure, you will experience restrictions with an HMO in terms of a provider network. Even so, you will also save by paying lower premiums when compared with a PPO. Then again, with the latter, there will be no more visits to a PCP every time you require medical help.

Filing claims

Your HMO Company pays healthcare providers. Therefore, you’ll save yourself the hassle of filing a claim. Under PPO, though, going to out-of-network providers’ means paying them yourself. Then you file a claim, and your insurance company reimburses you.

Prescriptions and pharmacy locations

Pharmacies part of the HMO network may not always be the ones located closest to you. So, you may have to drive farther to get your prescriptions filled. PPO will charge you a fee for it, but you can get a prescription filled almost anywhere.

Services, states, and plans-based differences

You can find how an insurance plan ranks based on consumer satisfaction through the quality rankings from the NCQA – a nonprofit. The organization evaluates all PPOs and HMOs that are available in each state.

The insurance company you’re with also determines the kinds of services/benefits you can get. Those can include:

  • Screenings, such as health and cancer
  • Prescribed medications
  • X-rays
  • Laboratory tests
  • Prenatal and well-baby care

What is available to you will also depend on the health plan you choose.

An HMO Cigna plan may be a good idea for people who are bound by their budgets. Thus, if you’re looking for more affordable premiums and copayments, it will be right for you.

Value Penguin, a customer spending tool, reported the monthly premium as $230 for HMOs. On the other hand, a PPO plan from Cigna is great for individuals valuing choice and wanting to see specialists. Value Penguin mentions that the premium for PPO was $251/month.

What you want out of your plan will influence which one you do choose. However, let your priorities and affordability range determine that for you!

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