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What is an HMO vs. PPO?

Two types of health insurance coverage are through an HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization). Each of these is considered a managed health care plan.

HMO

HMOs provide care from doctors who work for the specific HMO. A patient who needs a test or wants to see a specialist is required to receive a referral from a primary care physician.

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Coverage

Individuals who seek care outside the HMO’s network will have to pay for the care privately. Paid coverage is only available through the HMO and at its facilities.

Payment

Individuals pay the monthly premiums for the insurance as well as co-payments for services. Some HMOs offer deductible plans that can be used with Health Savings Accounts.

PPO

A PPO provides health care through a specific list of doctors. Members of a PPO can see a specialist with or without a referral from a doctor.

Coverage

PPOs offer a list of doctors who are part of the network. In addition, there is coverage to use doctors who are not in the network; however, the patient will pay more for the services.

Payment

Along with the cost of the monthly premiums, the insured will have to pay a percentage of the costs for services received until meeting the required deductible amount.

Source:

Financial Web: HMO vs. PPO

California Office of the Patient Advocate: HMO

California Office of the Patient Advocate: PPO

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Site Disclaimer: This site is designed for educational purposes only and is not engaged in rendering medical advice or professional services.
If you feel that you have a health problem, you should seek the advice of your Physician or health care Practitioner.

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