What is the difference between an HMO and a PPO plan?

Asked a year ago
An HMO (Health Maintenance Organization) and a PPO (Preferred Provider Organization) plan are two common types of health insurance plans, each with distinct characteristics. An HMO plan typically requires members to choose a primary care physician (PCP) who coordinates all medical care and provides referrals to specialists within the HMO network. HMOs usually have lower out-of-pocket costs and limited coverage if members seek care outside the network. On the other hand, a PPO plan offers more flexibility, allowing members to visit any healthcare provider without referrals, even outside the network. While PPOs often have higher premiums and deductibles, they offer more comprehensive coverage, including out-of-network treatments. Ultimately, the choice between an HMO and a PPO plan depends on individual healthcare preferences, such as the need for network restrictions or provider autonomy.
Jeff Whelpley is the editor / author responsible for this content.
Answered May 3, 2024

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