HMO vs. PPO: What's the Difference?

When you are choosing your medical insurance, it’s likely you’ll have a choice between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO). There are many differences between these plans, including the size of the plan network, the ability to see specialists, the costs of the plan, and coverage for out-of-network services. Knowing the differences between these plans can help you choose the right plan for your family.

Health Maintenance Organization Health Insurance Plans

Commonly called HMO plans, Health Maintenance Organization plans give you access to specific doctors and hospitals within its network. The network is composed of providers who meet quality standards for the plan, and have agreed to lower their rates for plan members. If you see a provider outside the network, your care will not be covered by your plan. HMOs also are more restrictive in their coverage, and will generally limit the amount of visits, tests, and treatments that are covered.

HMO Plan Key Points:

  • You may be required to select a primary care physician (PCP), who is responsible for determining your treatment.
  • You may need a referral from your PCP to see specialists or have special tests done.
  • You will need to pay the entire cost of treatment if you see an out-of-network provider.
  • Premiums are generally lower, and there is typically a low deductible or no deductible.

Preferred Provider Organization Health Insurance Plans

PPO plans, or Preferred Provider Organization plans, are generally more flexible when you are choosing providers. These plans offer a network of providers, but there are fewer restrictions on seeing out-of-network providers. Your PPO plan is likely to pay for non-network providers, though they may not pay the entire amount.

PPO Plan Key Points:

  • You can see your choice in doctor or specialist without a referral from your PCP.
  • You will still receive some coverage if you see an out-of-network provider, though you will receive more benefits from visiting in-network providers.
  • Premiums are higher, and your play will typically involve a deductible.

Choosing the Right Plan

When choosing the right plan for your needs, you will need to consider several things, including your medical needs, your income, and the availability of HMOs in your area. Determine if your plan has a network that suits your needs and offers enough providers and facilities in your area. A PPO can offer more freedom, but often at a higher cost.

To learn more about insurance options, get in touch with our Atlanta insurance administration professionals. We can help you find the right coverage for you or your business. Our team is exceptional at understanding the needs of professionals and business owners, and we can help you understand complex insurance options.

Contact our offices at the Insurance Specialists, Inc. by calling (888) 451-0883.