Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans have their own advantages, which can lead to having a hard time deciding which one to get. However, making this decision becomes easier when breaking down the individual details of each plan.

What Kinds Of Differences Can Two Policies Have?

Differences come from how the policy works and the parameters for when coverage applies. This can include whether one needs to select a primary care physician (PCP), the limitations of that plan’s coverage network, and whether a plan requires patients to get referrals from their PCPs before visiting specialists.

How Do HMO Plan Networks Compare To PPO Networks?

A network includes physicians and healthcare facilities under contract with a particular insurance plan. If a doctor has a contract with an insurer, he or she agrees to offer services at a lower cost in exchange for more potential patients.

HMOs have more stringent requirements when it comes to network coverage. In general, you will only receive insurance coverage if you get treatment within a network. Out-of-network coverage only applies in case of emergencies.

PPOs take a more flexible approach regarding network coverage. A PPO plan will still provide coverage for policyholders who get out-of-network treatment, but will offer better discounts for individuals who seek treatment within the network.

Which One Requires Selecting A PCP?

HMOs require choosing a PCP. This is a doctor who guides the entire course of your medical treatments. This also means you can’t see specialists without getting a referral from your PCP beforehand.

PPOs normally don’t require this. If you have a PPO plan, you can see whatever specialists you want and still get coverage for their services.

How Do These Differences Impact Costs?

While HMOs are more restrictive in terms of who and where you can get treatments from, they are cheaper than PPO plans. The premiums will be lower, and the deductible will be low-cost (some HMOs don’t even have a deductible).

PPOs are more expensive because of their flexibility. The premiums and deductibles are higher, but this also affords you the ability to have control over your own medical care.

Your Healthcare, Your Way

The Health Insurance Duo offers you an affordable way to keep your medical expenses from becoming overwhelming. We will get you the plan that works for you, your needs, and your budget – all at a competitive price. Call us today at (817) 501-9154.

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