Confused Between HMO and PPO Plans, Pick the One after having Good Understanding of Both

Confused Between HMO and PPO Plans

There are times in our lives when we have multiple choices and we happily pick the best option available. However, when it is time to choose the best health insurance plan, the multiple options start creating confusion. With so many options available we feel overwhelmed and find difficulty in picking the best plan to align with our healthcare needs and budget. However, the good news is that buying health insurance is not complicated, because today there are several health insurance portals operating that provide quotes of leading plans from different insurers.

Difference between HMO and PPO Plans

Two of the most popular major medical health insurance plans are Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. The major differences between both these plans are in the size of the network, plan cost, ability to see specialists without referrals, in-network size, and coverage for out-of-network services. The main difference between the two plans is the primary care doctor. With an HMO plan, you will have a primary care doctor from whom you can avail healthcare services, and if you have to see any specialist, then you will need a referral from your primary care doctor. Often HMO plans have lower premiums but every plan is different, so you need to carefully check the plan details to decide between an HMO or PPO plan. However, choosing between an HMO and PPO plan is specific to each individual’s needs.

Additional Key Feature Differences between HMO and PPO Plans

There are a few additional key feature differences between HMO and PPO plans that you need to consider before selecting a plan. PPO plans provide more flexibility in choosing a doctor or hospital and have fewer restrictions on seeing out-of-network providers. Sometimes PPO plans also cover the out-of-network visit costs. Whereas, HMO plans are considered as affordable with lower premiums and a lower annual deductible. Members of HMO plans will require referrals from their Primary Care Provider to visit specialists for non-emergency medical needs. Besides HMP plans provide a list of network providers along with specialists. However, if you visit a doctor outside of the network, then you will be required to pay the entire cost from your pocket.

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Key Features of HMO and PPO Plans

HMO plans provide an entire network of healthcare providers who offer healthcare services to all members of the plan. The healthcare provider network includes a Primary Care Provider assigned to you and your family. Your Primary Care Provider will be responsible for coordinating your health care services, and to provide you referral in case you need to see an in-network specialist.

Another difference between both these plans is their fees. HMO plans require you to pay copayment fees for every non-preventive medical visit and also give you access to in-network doctors and hospitals. The in-network healthcare providers of HMO plans provide healthcare services at lower rates to members while meeting set quality standards. However, if you visit the out-of-network provider, then your HMO plan may not cover the costs of your visit.

PPO plan allows plan members to visit any doctor who is within the insurance company’s network without requiring any referral. The members can even pay a visit to any specialist in the network without obtaining a referral from PCP. Members of PPO plans are not required to choose a Primary Care Provider and have fewer restrictions on seeing out-of-network providers. PPO plans as HMO plans also have copayments on non-preventive medical care. Though many PPO plans have an annual deductible and higher premiums.

Decide Between HMO and PPO Plans keeping your Future Needs in Mind

You need to keep your current and future healthcare needs in mind while deciding between an HMO and PPO plan. Besides, you should also weigh the pros and cons of both these plans to make an informed decision that is right for you as well as your family. Before picking any of the plans, you need to check the list of in-network providers for your area. You should check the availability of HMO plans in your local area, and carefully assess your income. You also need to determine if you will need to see specialists in the upcoming year. Careful considerations of all these factors will help you pick between the HMO and PPO plans that will prove the right choice for you and your family.

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