Which one is best for you?

You’ve probably heard the terms HMO and PPO.  We created a simple side-by-side chart that shows the basic features of HMOs and PPOs.  Remember, there is no right or wrong choice when it comes to selecting your health care plan.  Having a clear understanding of these plans and how they work will help you in choosing the plan that’s best for you, your family and your budget.

Short Video

What is an HMO?

What is a PPO?

Differences between HMO and PPO (comparison chart)

What is a PPO?

PPO stands for Preferred Provider Organization.  A PPO health insurance plan allows for more flexibility and more choices when it comes to your healthcare.  It offers a network of healthcare providers to choose from and you have the freedom to receive care from within that network or choose an out-of-network doctor, specialist or hospital without a referral.  Keep in mind, however, that your out-of-pocket medical costs are lower when you choose an in-network provider.

Flexibility

PPO plans do not require you to choose a Primary Care Physician (PCP) and do not require referrals.  Let’s say you have a doctor or specialist that you like and have been seeing for years.  With a PPO plan you could continue your visits whether they are in-network or out-of-network and without the need for a referral.

It is important to remember, that while you can receive care from any doctor, specialist or hospital you choose, you will save more money by choosing an in-network provider.

Higher Monthly Premium

The greater flexibility of a PPO often comes with a higher monthly premium, a deductible that must be met before coverage begins, and co-pays.  While you can choose to use doctors, specialists or hospitals outside of your network, there will be higher out-of-pocket costs associated with these visits.

What is an HMO?

HMO stands for Health Maintenance Organization. With an HMO plan, you must choose a Primary Care Physician (PCP) from a network of local healthcare providers who will refer you to in-network specialists or hospitals when necessary. All your care is coordinated through that PCP.  HMO plans generally won’t cover out-of-network care except in a true emergency.

Lower Cost

With an HMO plan, your out-of-pocket medical costs and monthly premiums will generally be lower than a PPO.

Selecting a Primary Care Physician (PCP)

With an HMO plan, you’ll select a Primary Care Physician who will be your contact for all your healthcare and they will connect you to specialists or other health care providers.

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