HMO PPO EPO WTF IDK NVM

06/09/21 • 21 min

Doxcost - The Ultimate Guide To Health Insurance

#025 - HMO PPO EPO WTF IDK NVM takes a look at the health plan terms you see all of the time, but know nothing about. Scott W. Dowling tells you what you need to know and what you don't. This is the first of two shows discussing so-called networks and how they affect the price of your health insurance.
Health Maintenance Organizations are said to have started as prepaid medical care for loggers in the Pacific Northwest dating back to 1900, but the first prominent HMO was started by Henry J. Kaiser the East Bay Area city of Richmond, California during World War II. Kaiser built and staffed a field hospital for his shipbuilding employees. Kaiser was an industrialist and philanthropist with steel, aluminum and other businesses across the United States. He cared for his employees and the communities where they operated by opening fully staffed hospitals that were the original HMOs.
Learn more about the first HMO here
Preferred Provider Organizations started to pop up in the early 1980s as Health Maintenance Organizations fell out of favor. The more flexible PPO offered similar savings to HMOs while allowing insured patients to see the doctors of their choice. While the BUCA (BlueCrossBlueShield, United Healthcare, Cigna, Aetna) subsidiaries created so-called networks of providers, MultiPlan was and is the largest independent Managed Care Organization involved in the Preferred Provider Organization model's development.
Learn more about MultiPlan NYSE:MPLN
Long before the Health Insurance Portability and Accountability Act was signed into law by Bill Clinton or the Patient Protection Affordable Care Act was signed into law by Barrack Obama, both Democrats by the way, Republican Richard Nixon made the first move into federally mandated employee benefits with The HMO Act of 1973. This law provided financial assistance for the further development of HMOs across the United States and required employers to offer an HMO alternative to traditional insurance if an eligible HMO operated in their area.
Learn more about The HMO Act of 1973
Thanks, as always, for your support. I appreciate you very much! Tell your family, friends, coworkers, boss and firm administrator to listen to Doxcost wherever they get their podcasts.
Our next episode will be Part 2 of HMO PPO EPO WTF IDK NVM where we'll discuss what is changing and evolving in the HMO/PPO world and what it means for you, your family and your company's employees.
Be sure to listen to my pal, Morgan Fingleton, at doxcost.com/music
Sign up for your free Health Savings Account at doxcost.com/lively

Previous Episode

Traditional PPO vs. High Deductible Health Plan With Health Savings Account

#024- Traditional PPO vs. High Deductible Health Plan With Health Savings Account answers the question posed by an anticipated Dad to be. Is it better to switch from a high deductible health plan (HDHP) with Health Savings Account (HSA) to a traditional PPO plan due to a possible family addition? Listen in to what Scott has to say!
Most people do not understand how Health Savings Accounts work, nor how they help you save REAL money.
Would you light a match to a dollar bill? Then why are you not using a Health Savings Account? Because lighting a match to your money is what you do when you enroll in a traditional health plan.
Learn the rules for Health Savings Accounts
Traditional PPO vs. High Deductible Health Plan With Health Savings Account highlights some easy to understand but often misunderstood concepts.

Eligible High Deductible Health Plans can have a deductible as low as $1,400
Anyone can contribute to your Health Savings Account - not just you
You are not required to use the HSA provider through you employer
You are not required to contribute only through payroll deduction
You can contribute a lump sum to your HSA at anytime during the year
Not all HSA providers allow for funds to be invested or offer limited options
Many HSA providers charge you a fee - choose one that is free!

Scott prefers Lively HSA - it is FREE, ONLINE with FULL INVESTMENT options
To calculate the amount you save on every dollar you spend with a Health Savings Account, divide 1 by 1 minus your tax rate or 1 / (1 - Your Tax Rate)
For the 22% bracket the calculation would be
1 / (1 - .22) or 1 / .78 = 1.28
Rather than earning $1.28, paying Uncle Sam tax at 22% of $1.28 or 28 cents and having $1.00 left to pay the doctor or hospital,
Using a Health Savings Account, you earn $1.28, pay Uncle Sam 0% tax on $1.28 or NOTHING and have $1.00 left to pay the doctor or hospital and STILL HAVE 28 CENTS IN YOUR POCKET TO SAVE AND INVEST UNTIL WELL AFTER RETIREMENT!
Learn your Federal Income Tax Rate here

As always, I appreciate you! Tell your family, friends, co-workers, boss and firm administrator to listen to Doxcost!
In the next episode, we'll cover all the things you don't know about HMOs, PPOs and EPOs. See ya then!

Next Episode

HMO PPO EPO WTF IDK NVM Part 2

#026 - HMO PPO EPO WTF IDK NVM Part 2 looks at how HMO and PPO networks have run their course, what approach employers are now considering and what employees can expect in the near future.
Healthcare Is Not Health Insurance
The entanglement of healthcare and health insurance has led to rampant medical inflation for decades, much higher than the rate of inflation for the overall US economy. The genesis of the rapid increase in the rate of medical inflation can be linked to the introduction of Medicare in 1967.
Can HMOs Stem Tide of Rising Costs?
Only a few years after President Johnson signed the law creating Medicare, President Nixon signed a law providing for the growth of Health Maintenance Organizations (HMOs) as a way to slow the pace of rising medical costs. HMOs proved to be financial failures. They either went out of business or changed their business model.
PPOs Pick Up Where HMOs Left Off
Preferred Provider Organizations offer insured patients choice and flexibility instead of the all or nothing HMO model. PPOs succeed in offering pricing discounts to insurance plans in return for the insurance company steering its insured customers to select hospitals and doctors.
Today's PPO and HMO Plans Have Run Their Course
PPO and HMO plans no longer provider effective discounts. To the contrary, medical providers have wasted and abused nearly $1 TRILLION ANNUALLY, according to a study by the Journal of the American Medical Association.
Learn about JAMA Waste Report here
Reference Based Pricing
Employers who pay the vast majority of the premiums for over 150 million Americans with health insurance are tired of the antiquated HMO/PPO offer of discounts and are charting a new course. As a result, employers are not relying on so-called networks and are negotiating the price of healthcare services up front. Employers are engaging healthcare providers through Reference Based Pricing.
Learn about Reference Based Pricing here
The Big Heist
Thanks for your continued support. I appreciate each and everyone of you very much! Tell your family, friends, neighbors, coworkers, boss, office manager and firm administrator about Doxcost. Listen on Apple Podcasts or wherever you get your shows.
Next up, we'll look at who your health insurance company really is........
Set up your Health Savings Account here....I prefer Lively HSA