HMO vs. PPO - What does it mean?

Insurance can be a very confusing industry and finding the right coverage difficult. Let’s try and clarify things!

What is an HMO network? What about PPO? HMO stands for Health Maintenance Organization. A Health Maintenance Organization is a type of plan network. A plan’s network is the doctor’s offices, hospitals and specialist your insurance provided allows you to go to. PPO stands for Preferred Provider Organization.

Under an HMO network the network is often local to where you bought the coverage and expenses to providers outside the network are covered at 0%. Yes, that is right. If you get into an accident while on vacation in another state, your health plan will typically cover none of the expense.

In contrast a PPO plans network is often nationwide and even if you end up at a provider that is out of network a portion of the expense will still be paid. This is the massive advantage of going for a PPO options.

An HMO network will also require that any specialist visit needs to be referred by your PCP before you can get the care you need. Meaning valuable time that could be used to catch an illness early, must be spent waiting for multiple separate appointments in which your doctor may just deny the need for referral.

A PPO plan on the other hand has no such referral requirement, really putting you the patient in charge of your own healthcare.

Many people think PPO plans are only available through group insurance, because they have looked on the Affordable Care Act (ACA) marketplace and found no such options. Fortunately, they are wrong there are non-ACA plans available that give individuals the freedom to choose their own health journeys.

For more information, schedule a call and I will be happy to help find the coverage that is right for you.