{"id":352586,"date":"2017-07-19T17:21:41","date_gmt":"2017-07-19T22:21:41","guid":{"rendered":"https:\/\/ability-fl-prod.internetbrands.com\/ability-law\/consumer\/insurance\/hmo-vs-ppo-health-insurance.html"},"modified":"2024-03-26T10:24:31","modified_gmt":"2024-03-26T15:24:31","slug":"hmo-vs-ppo-health-insurance","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/consumer\/insurance\/hmo-vs-ppo-health-insurance.html","title":{"rendered":"HMO vs. PPO: Which Health Insurance Plan Is Best for You?"},"content":{"rendered":"\n
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HMO vs. PPO: Which Health Insurance Plan Is Best for You?<\/h1>\n
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\n By Oni Harton, J.D.<\/a> | Legally reviewed by Melissa Bender, Esq.<\/a>\n | Last updated\n
\n \n <\/i>\n Legally Reviewed\n <\/summary>\n\n
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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

\n \n <\/i>\n Fact-Checked\n <\/summary>\n\n
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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n

Health insurance<\/a> can give you peace of mind and ensure you maintain good health or promptly address any pressing medical needs. A good health insurance plan<\/a> can help you control your health care costs.<\/p>\r\n

With all the choices available, choosing the right plan to meet your health care needs takes some thought. You may have options through your employer. You may also select a Marketplace health insurance plan<\/a>. Regardless of where you get your coverage, there are decisions to make.<\/p>\r\n

One of the primary decisions you’ll need to make about health care services is selecting a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO).<\/p>\r\n

This article will discuss the pros and cons of HMO vs. PPO insurance plans. It can help you decide which health insurance plan is best for you.<\/p>\r\n

HMOs and PPOs Explained<\/h2>\r\n

Choosing the right plan for your medical services is critical. HMOs and PPOs are two types of managed health care<\/a> plans. There are key differences between an HMO and a PPO. Deciding between a PPO and an HMO depends on your needs. The main differences between HMOs and PPOs are affordability and flexibility.<\/p>\r\n

What Is an HMO?<\/h3>\r\n

HMOs have a network of health care providers, including doctors, hospitals, and others who provide services. An HMO typically offers lower costs than other plans because it has negotiated rates for members.<\/p>\r\n

HMOs are for a lower out-of-pocket cost than other types of plans. It works with health care providers in a contract with the HMO. With an HMO plan, you’ll likely pay a monthly premium and a copay when you get medical services.<\/p>\r\n

HMO plans often focus on wellness and prevention. They require people to choose a primary care doctor from a network of doctors. The primary care physician must provide a referral for specialists.<\/p>\r\n

One of the key characteristics of an HMO vs. a PPO insurance plan<\/a> is the need to choose a primary care physician (PCP). HMOs typically require you to select a PCP who coordinates your medical care. You choose the PCP from a list of physicians within the plan’s network of approved providers. PCPs have agreements with the HMOs to charge lower rates for services.<\/p>\r\n

HMOs will not typically cover out-of-network care except in emergencies. If you use a provider outside the HMO’s network for a non-emergency service, an out-of-network provider, HMO plans will usually not pay.<\/p>\r\n

If cost is your most important consideration, HMO plans are probably your best option. The monthly premiums<\/a> and deductibles<\/a> costs are generally lower than other plans.<\/p>\r\n

What Is a PPO?<\/h3>\r\n

A PPO is a type of plan that offers a network of health care providers for members to use. Network coverage is extensive. You won’t likely need to choose a primary care physician or need a referral from that physician to see a specialist. Members can bypass the referral process and schedule an appointment directly with a specialist.<\/p>\r\n

You can even get out-of-network services from health care providers without a referral for an extra cost. A PPO allows freedom to get health care service from any health care provider in or out of your network. But, you pay less using providers in the PPO’s network.<\/p>\r\n

Related to the cost factor is the insurance claims process<\/a>. Because HMOs only cover in-network providers, the insurance claims process is usually seamless. You won’t typically need to file your own claim. But, with some PPOs, you may have to pay for services first and then file a claim for reimbursement. This is especially true if you use an out-of-network provider.<\/p>\r\n

PPOs offer greater flexibility in selecting health care providers. So, if flexibility and choice are essential to you in a health care plan, a PPO may be a good choice. PPO plans generally have a higher monthly premium than most HMOs, but in return, you get more choice and flexibility.<\/p>\r\n

Considerations When Choosing Your Health Care Plan<\/h2>\r\n

Whether to sign up for the HMO, PPO, or some other plan depends on your needs and circumstances<\/a>.<\/p>\r\n