Not All Insurances Types are Equal: HMO vs PPO

Not all Insurance is Equal: HMO vs PPO

Not All Insurances Types are Equal: HMO vs PPO

When it comes to health insurance, one of the first things that you will likely notice is that not all insurance plans and programs are created equal. A lot of people have a lot of questions regarding their health insurance, primarily when it comes to the difference between HMO and PPO. 

These are the two main types of managed care plans available in the United States. While both HMO and PPO are managed care plans that are designed to help reduce medical care costs—without sacrificing quality, there are some notable differences between the two types of insurance.

HMOs, stand for Health Maintenance Organization plans, while PPO stands for Preferred Provider Organization plans. It is more common for companies to offer PPO plans for their employees over HMOs. When it comes to the differences between these two types of insurances, one of the first things that patients notice is the premiums.

Typically, premiums for HMOs are lower than they are for PPOs. 

However, there is often a smaller and more restricted provider network that you will have to deal with first. So, while HMOs typically have the lowest out-of-pocket costs, if you go to a provider who is out of network, you are going to have to pay 100% of the costs associated with your care and treatment.

With an HMO, you will likely also need to choose a Primary Care Physician who you will need to go through for referrals for specialized medical care.

With a PPO, you can see any health care provider in the insurance company’s network, and you can go to specialists without a referral.

This isn’t the only potential hurdle you may have to deal with when you have an HMO plan. While HMOs often have low or no deductibles, you may still need to pay a copayment for non-preventative visits. PPO plans typically also have copayments, but you will need to pay annual deductibles and higher premiums as well.

Simply put, if you value more flexibility and fewer restrictions with who you see, the PPOs are a better option. But if affordability is more important than flexibility, and you don’t mind getting PCP referrals for non-emergency visits—then you should consider an HMO plan.

Each has its benefits, and each can help you get the coverage you want, it just depends on your individual needs. We always recommend talking to an insurance specialist first before choosing any new health insurance plan.

Here at Continuum Internal Medicine, we want to make sure that quality health care is as accessible as possible to our patients. This is why we are happy to educate you on different types of insurance, including HMOs and PPOs. If you have questions on your health or on how your insurance can help keep you covered, make an appointment with Continuum Internal Medicine by calling us at 817-617-8650 today. 

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