HMO and PPO are two common types of health insurance plans. Here are the key differences between them based on the search results:
HMO (Health Maintenance Organization)
- You must use in-network providers for all of your care. Out-of-network care is only covered for urgent care and emergencies.
- You must choose (or designate) a network provider to be your PCP. Your PCP will be responsible for managing and coordinating all of your care, including providing referrals to see specialists.
- HMOs are generally less expensive than PPOs. They offer mid-range monthly premiums and, depending on the plan, may have lower out-of-pocket costs.
- HMOs usually have lower monthly premiums. Both may require you to meet a deductible before services are covered, but it’s less common with an HMO.
- HMOs typically don’t provide coverage for out-of-network providers unless it’s an emergency.
PPO (Preferred Provider Organization)
- You can access any doctor or hospital, but you would be responsible for coordinating your care. Seeing doctors inside the network will generally have lower costs for services than seeing a doctor outside of the network.
- You are not required to choose a PCP. You can see a specialist without a referral and are free to use providers both in and out of the network.
- PPOs offer some of the greatest flexibility of all health plan types.
- PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
- With a PPO, your monthly premiums may be higher, but you will have some coverage if you go out-of-network.
When deciding between an HMO and a PPO, its important to consider whats most important to you: cost or flexibility. An HMO plan might be right for you if lower costs are important and you don’t mind choosing your doctors from within the HMO’s network. A PPO plan might be right for you if you already have a doctor or team of specialists you want to continue seeing but might not be in your employer’s HMO plan network. A PPO plan is also generally more expensive than an HMO plan.