PPO vs. HMO Insurance - What's the Difference? - Affordable Health Plans

When it comes to health insurance, having choices is critical, and you have the option to select between a few different plan types. Today we’re going to cover two plan types that you have probably heard of quite a few times already. HMO and PPO plans are something that we’ve mentioned in previous articles and if you’ve read them, then you already know that much of the difference lies in the network size and the option to see specialists.

In addition to that, they deal with the ability use out of network services, but what else is there? What really makes the difference between these two? Today we’re going to take a closer look so that you can decide what type of coverage you’re going to need.

A Look at HMO Health Insurance Plans

HMO is an acronym, standing for Health Maintenance Organization, and this type of plan gives you access to only certain healthcare providers. The providers that you access need to be within the network, and the first thing you need to know is that this network is not established at random. Instead, the network you find yourself part of is comprised of healthcare providers that have come together and agreed to provide lower rates to plan members. In addition to that, even with the lowered prices, they agree to uphold certain standards and ensure that everyone within the plan gets the treatment that they both need and deserve. There some potential disadvantages which include:

  • Limited Office Visits
  • Limited Tests
  • Limited Treatment
  • Inability to see Out of Network Provider

These plans will also require you to choose a PCP or Primary Care Physician at the outset who will then be in charge of your treatment for the duration. As you move forward you will also find that you need a PCP referral to see a specialist which can include an endocrinologist, gastroenterologist, and more. You will also need a referral for life-saving procedures such as a colonoscopy, etc. That said, make sure that your physician is someone that you can trust to take you seriously.

What are PPO Health Insurance Plans?

HealthInsurancePlanIf you are looking for something that has a little bit more flexibility than an HMO then a PPO might be the direction that you want to head. These definitely provide you more options when it comes to choosing your doctor or hospital! Like an HMO, a Preferred Provider Organization (PPO) has a network of providers but if you want to see an out of network provider then you still have the option. While you may need to pay out of pocket for the out of network provider it will be at a much lower rate, which definitely reduces the financial burden on you.

Some of the features of a PPO include:

  • Ability to see Out of Network Providers
  • See a Doctor/Specialist without a Referral from your PCP

These two benefits are significant, but it should be noted that if you see an out of network provider you will need to pay a bit more. In addition to that, the premiums for a PPO are going to be inherently higher than what you would encounter with an HMO, but there is almost always a deductible.

The Comparison

All in all, HMOs are usually more affordable, but they give you less coverage and greater restrictions. It comes down to what you can afford and how comfortable you are with the in-network providers, especially if you choose to go with an HMO. With all of that being said, we would strongly recommend that you do a bity of research to determine whether or not the doctors within the HMO network are respectable, and whether or not they will care for your needs.

Thanks to the internet and user reviews, this is much easier to achieve than it has been in the past. Important factors in choosing between an HMO and a PPO will be the area you live in, your income, and of course any conditions that you might be suffering from. It is, of course, crucial to making sure that the insurance company you choose will cover your current issues. It can be a tough decision but there is always a logical path to take.

The choice of a healthcare plan is not something that you want to rush by any means. You need to sit down, think, and even talk to others who have sought out similar coverage in the past. The healthcare industry and the health insurance industries are changing considerably under the current administration and it is difficult to see just how it will all turn out, at least at the moment. That being said, keep an eye out and choose the coverage that is going to be best for you.


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