01
HMO vs. PPO in one paragraph each
HMO plans require a primary care doctor and referrals to see specialists, in exchange for lower premiums and lower out-of-pocket costs — but only in-network care is covered except in emergencies.
PPO plans let you see specialists without a referral and offer some out-of-network coverage, at the cost of a higher premium. If you have an established specialist or travel often, a PPO's flexibility can be worth the extra cost; if you're healthy and cost-focused, an HMO's structure rarely gets in the way.
02
The five numbers that determine your real cost
| Term | What it means |
|---|---|
| Premium | What you pay monthly regardless of care used |
| Deductible | What you pay before insurance starts covering costs |
| Copay | Flat fee for a specific service (e.g., $30 for a visit) |
| Coinsurance | Your % share of costs after the deductible is met |
| Out-of-pocket max | The most you'll pay in a year before insurance covers 100% |
The trade-off: lower premium plans almost always carry a higher deductible and out-of-pocket max. The right choice depends on how predictable your medical spending is, not just the sticker price.
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03
Reading an Explanation of Benefits (EOB)
An EOB isn't a bill — it's a summary of what your insurer paid and what's left. Check three lines every time:
- Billed amount vs. allowed amount — the discounted rate your insurer negotiated with the provider
- Amount insurer paid — what's been covered so far
- Patient responsibility — what you may still owe, which should match the actual bill from the provider
If the patient-responsibility figure on the EOB doesn't match your provider's bill, that's the first thing to dispute — billing errors are common and catching them early is easier than after collections gets involved.
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