Health insurance PPO vs. HMO: How much do you know about the differences between the two? Read on to learn more about the differences between them.

Health Insurance PPO vs. HMO: What Are the Differences?

Did you know that over 28 million Americans don’t have health insurance? Finding the right health insurance benefits is crucial to maintaining your health. It allows you to treat health conditions and offers free preventative care like screenings and vaccines.

If you’re looking to buy an insurance plan on your own or select one through your employer, you’ll have to decide between health insurance PPO vs. HMO. To make the best decision for your health, you’ll need to understand the key difference between the two.

Keep reading this health insurance guide to learn everything you need to know about PPO and HMO insurance plans.

What Is an HMO?

A health insurance HMO allows access to specific doctors, hospitals, and other healthcare facilities in its network. HMO networks are made up of healthcare providers that agree to charge plan members lower rates.

If you have an HMO plan, you’ll only be covered if you see a provider in your HMO’s network. If you see a non-network provider, you may have to pay full price or will only get partial coverage at best.

Some other important factors about HMOs include:

  • There may be restrictions that limit tests or treatments
  • HMO plans require you to select a primary care doctor (PCP)
  • You usually need a referral from your PCP to see a specialist
  • HMO plan premiums are generally lower
  • Typically there is a low deductible

What Is a PPO?

A health insurance PPO gives you more flexibility than HMO plans when choosing doctors and hospitals. You’ll also get access to a network of different providers, but you’ll experience fewer restrictions when you see a non-network provider. PPO insurance plans will pay if you see a non-network provider, but it can be at a lower rate.

Other essential features of PPO plans include:

  • You can see a specialist without needing a referral from your PCP
  • You don’t need to select a PCP
  • PPO plans are more expensive
  • You’ll usually have to pay a deductible
  • Seeing a non-network doctor may require you to file a claim to get reimbursed

Health Insurance PPO vs. HMO

The main difference between these plans is the cost and flexibility. To determine which plan to purchase, you’ll need to decide which type of plan will work best for your personal situation.

If you need to keep your costs low to maintain your budget, then an HMO plan may be the best option for you since premiums and deductibles tend to be lower. An HMO plan is also a good option if your preferred physician uses an HMO plan.

However, if you want more flexibility and the ability to choose who you see, then a PPO might be better for your situation. Remember, with a PPO, you won’t need to select a primary care physician. You’ll also have more healthcare facilities and specialists to choose from.

To better understand affordable healthcare plan options, check out for more information.

Choosing the Best Health Insurance

Health insurance PPO vs. HMO: Now that you know more about these plans, you’ll be better able to choose a plan that works for you.

Remember, before you sign up for a plan, do thorough research. Be sure to check the plan’s providers, monthly cost, referral rules, and how much of a deductible you’ll need to pay.

For more health insurance tips and health-related articles, check out the rest of our blog today!

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