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What's the Difference Between HMO and PPO?

12/01/2015

HealthMarkets -- With open enrollment underway, and health insurance a priority, which type of health care plan should you opt for, an HMO or PPO? Here's what you need to consider.

Knowing the difference between HMO and PPO plans can help make sure your family's medical needs can be covered. Though these plans carry many similarities, having the ability to choose which healthcare professionals you can see, and how much coverage you'll get, can help frugal families get the care they need.

HMO vs. PPO

HMO stands for Health Maintenance Organizations. PPO stands for Preferred Provider Organizations.

With either plan option, you can know about the different access you have to the network of physicians, specialists, and healthcare professionals through your provider.

Here are some features of HMOs:

Network: With an HMO, you choose your primary healthcare doctor from a list of providers. Your doctor can then refer you to specialists when needed. This means you may have less flexibility with your healthcare options.

Costs: While you may have less flexibility, you may spend less money, as long as you stick with providers within the network. Rather than a deductible, many HMO plans require copays per office visit, which may be more manageable amounts for your budget and may give you fewer out-of-pocket costs.

Ease: With an HMO, you don’t have to submit insurance claims. As long as you choose a primary doctor who is in the network, this type of plan may come with minimal hassle.

Here are some features of PPOs:

Network: Like an HMO, a PPO provides an approved network of providers; however, you can still see healthcare providers outside the network -- just for a higher cost.

Costs: Most healthcare providers will generally offer medical services at a discounted rate for those with PPO plans. Unlike an HMO, a PPO provides some coverage for doctors outside of your network; however, it will cost a higher percentage. Also, a PPO will generally have a small copay, as well as a deductible that needs to be met prior to benefits kicking in.

Ease: A PPO may be an easier choice because you don’t have to choose a primary healthcare doctor. You may also see specialists without a referral.

Which one is right for me?

If your family can have all their medical needs met at a single office, an HMO plan would help cover all your needs. However, if your family needs more flexibility to access to several specialists, a PPO plan may be right for you.

HealthMarkets Insurance Agency has thousands of licensed, knowledgeable agents across the country who can help you make the right decisions about your health insurance needs. To learn more about the difference between HMO and PPO, or for any other health insurance questions, contact them today or find a licensed agent in your area. Representatives provide personalized assistance over the phone 24/7. Visit HealthMarkets.com, for more information.

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The views and opinions expressed in these articles do not necessarily reflect those of College Central Network, Inc. or its affiliates. Reference to any company, organization, product, or service does not constitute endorsement by College Central Network, Inc., its affiliates or associated companies. The information provided is not intended to replace the advice or guidance of your legal, financial, or medical professional.