What is the Difference Between an HMO and a PPO Plan?

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are two of the most common types of health insurance plans. While both offer coverage for medical expenses, there are some key differences between them.

Monthly Premiums

When it comes to monthly premiums, HMO plans usually have lower rates than PPOs. This means that you will pay less each month for your coverage.

However, you may also have to pay more out-of-pocket for medical expenses. On the other hand, PPOs usually have higher monthly premiums, but you will have more flexibility in terms of using in-network and out-of-network providers without needing a referral.

Network Size

HMOs tend to have smaller networks than PPOs, meaning that you may have fewer options when it comes to choosing a doctor or specialist. PPOs usually have larger networks, so you may be able to find more doctors and specialists in your area.

SpecialistsHMOs generally require you to get a referral from your primary care physician before you can see a specialist. PPOs usually do not require referrals, so you can consult with a specialist without having to go through your primary care physician first.

Out-of-Network Coverage

HMOs typically do not offer any coverage for out-of-network providers. PPOs usually offer some coverage for out-of-network providers, although it is usually less than what is offered for in-network providers.

Emergency CareIf you are affected by a disaster or emergency declaration by the president or governor, or by the announcement of a public health emergency by the Secretary of Health and Human Services, CareFirst has created its plans with the freedom of patients in mind to see the doctor of their choice, and the HMO plan continues to cover a wider network of doctors than that of many other health insurance providers.

Enrollment Periods

Whether you've decided on an HMO or a PPO, you can enroll in whichever plan you choose each fall during the open enrollment period (OEP) for individual health insurance or the annual election period (AEP) for Medicare members. When it comes to choosing between an HMO and a PPO plan, it's important to consider all of the factors mentioned above. HMO plans tend to be more affordable but offer less flexibility when it comes to seeing specialists and accessing out-of-network providers.

On the other hand, PPO plans are usually more expensive but offer more flexibility when it comes to seeing specialists and accessing out-of-network providers.

Tommy Gair
Tommy Gair

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