There are a lot of options available, but knowing the difference between those plans and what your specific needs are will help you pick the right one. What is the difference between a PPO and an HMO you ask? Read on and all will be made clear.
HMO – Health Maintenance Organization
With an HMO plan, you pick one primary care physician. Once you make that selection, all your health care services will go through that doctor.
If you need to see another health care professional, you’ll need a referral first (except in the case of an emergency). If you do visit a health care professional who isn’t in your network, you’re insurance won’t typically cover the visit.
Let’s say you develop a skin rash. You’ll need to go to your primary care physician first. If they can’t help you they’ll give you a referral to a specialist, a dermatologist in this case, that’s in your network.
One exception to this rule is that women don’t need to get a referral to see an obstetrician/gynecologist (OB/GYN) in their network for routine services such as Pap tests.
The goal of going through your primary care physician is less paperwork and less health care costs.
PPO – Preferred Provider Organization
With a PPO you get more flexibility on who you see, but you also get increased out of pocket costs.
You don’t need a primary care physician with a PPO. You can see a specialist without a referral. If you stay inside your network you’ll have a smaller copay. Another thing to consider is that not all services are covered by a PPO.
What Is The Right Choice?
What you choose depends on what is most important to you. Do you want everything to go through a single physician? Do you want to decrease out of pocket expenses? In general, an HMO will have less cost but it will also restrict who you see. A PPO gives you more flexibility but at a higher expense.
So again, what is the difference between a PPO and an HMO? In a nutshell, it’s the cost of your plan, out of pockect expenses and flexibility of who you get to see.