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HMO vs. PPO: Which Provider Network Fits Your Needs?

Ever wonder what the difference is between HMO and PPO? It’s a decision we all face when choosing a health insurance plan, but what are the differences, and which one is right for you and your family? They both have networks of doctors, hospitals and health care providers. They cover the ten essential health benefits like vaccinations, prenatal care and cancer screenings. However, there are differences you need to know about to help you decide between an HMO and PPO.  

The BeWell marketplace includes medical HMO plans and dental PPO plans, and most job-based insurance plans offer both. Let’s break down the differences to help you choose:

So what are HMOs

HMO stands for Health Maintenance Organization where you can seek care from health care providers that are in-network and typically offer lower deductibles and out-of-pocket costs. The network has an agreement in place to keep costs for health care services at certain rates. So, you will only pay your co-pay for covered services and no surprise bills when you check out of the doctor’s office.

HMOs are a great choice if you just need basic medical care throughout the year, like your annual check-ups and immunizations. With a HMO, you will also be required to designate a primary care provider. They are your partners in health and will help guide your medical decisions and refer you to specialists. Getting to know your primary care provider is good practice, the more they know about you and your family medical history, the better they can help guide you on your health journey.

Now let's get into PPOs

PPO stands for Preferred Provider Organization and are like the first-class tickets of health insurance plans. They give you more flexibility to see doctors and health care providers both in- and out-of-network. HMOs will only cover services out-of-network in emergencies.

PPOs have higher premiums, and you may have to cover medical costs until you meet your plan’s deductible. PPOs are a great choice and safeguard if you travel often or have a complex medical condition that requires you to see an out-of-network doctor or facility. You also have the freedom to see a specialist without a referral from a primary care provider.

Related reading: How to Read Your Summary of Benefits and Coverage

One more thing to consider

When deciding between an HMO and a PPO, check if your current doctor and health services are covered within the plan’s network. If they are, opting for an HMO may help you save money on healthcare costs. Most health insurance carrier websites have a search tool to verify if your doctor is within their network. However, sometimes their database is not up to date, so your best option is to pick up the phone and call both your doctor and the carrier to verify. 

We are here to help!

You can also connect with a Certified Assisted anytime to help you review each plan’s network. 

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