When you first enroll in a health insurance plan (whether through open enrollment or a special enrollment period), you’ll more than likely need to choose between a HMO and a PPO plan and secondly a doctor and maybe a medical group as well.
Medical group? Isn’t that my insurance company?
A lot of times people will get confused about what’s a medical group and what’s a health insurance company. They will sometimes think that “Regal Medical Group” or “AltaMed” is their health insurance when it is actually their medical group.
A medical group is a network of doctors and healthcare providers who work together to coordinate and manage your care in one connected system.
Most of the time you will find that when you choose your primary care provider on a HMO plan that you didn’t just choose a doctor, you also chose a medical group at the same time.
When you choose your health insurance plan, you will typically choose from one of the two different plans:
- HMO (health maintenance organization)
- PPO (preferred provider organization)
When you’re enrolled on an HMO plan, your care is typically organized through a medical group. You’ll choose a primary care provider (or PCP) and if that doctor belongs to a specific medical group, you’ll be a member of that medical group as well.
The medical group is where you’ll have your care managed for things like referrals to specialists (ex: cardiologist, podiatrist, etc.) You may also need to go through your medical group to get authorization for certain services (in addition to your health insurance company).
This is why it’s highly important to choose the right doctor and medical group combo for your needs.
Are you coming off of a plan and need to continue seeing the same doctor or set of doctors? Need access to the same medical group? Newly enrolling on a health plan by yourself?
Feel free to reach out and we can help with a needs analysis to see which is the best fit for you! Call us at (626)399-7082 or by filling out a contact form and we’ll reach out to you.
Need to sign up for a new health insurance plan? If you have a qualifying life event, we may be able to help you enroll with a special enrollment period. We’re here to help!
