Difference Between PPOs and HMOs
Choosing the right health insurance policy is the best way to ensure that you have the right amount of protection for any health issues. However, with all of the choices that are available, choosing the right policy can be easier said than done. Knowing the difference between PPO and HMO insurance can be a deciding factor when it comes to choosing the right policy.
A health maintenance origination plan, or HMO, has lower premiums than a PPO. However, they also come with less flexibility. HMO plans have contracts with specific health care facilities and professionals in order to create a “provider network.” When you have an HMO plan, you only have to pay a small co-payment when you visit a hospital or doctor that is within the network. With low premiums and co-payments also comes less flexibility. When you sign up for an HMO plan, you have to choose a primary care provider who is part of the network. If you have a current physician that is not part of the network, you will have to switch doctors or pay out of pocket to continue seeing your doctor. Most HMOs will also not pay for any non-emergency care that is performed by a physician that is out of the network.
A preferred provider organization plan, or PPO allows you to skip any referrals needed to see a specialist. Just like an HMO, PPOs have contractual agreements with health care providers to create a “provider network.” If you choose to see a doctor that is part of the network, you will pay very low premiums. However, if you choose to see a doctor that is out of the network, your insurance will still pay for part of the bill. Another benefit of a PPO plan is that you do not need to get permission from your primary physician’s permission to see a specialist.