What's the Difference Between an HMO and PPO Plan?
There are several differences between HMO and PPO plans. HMO, or Health Maintenance Organization plan, requires the patient see a specific doctor based on several different factors. An HMO plan does not allow a patient to see a doctor that isn't assigned to them by the insurance company. Typically, a patient wishing to see a doctor not on their insurance company's list of health care providers, will need prior approval.
A Preferred Provider Organization, or PPO offers the patient much more freedom in choosing their own doctor. As with an HMO, the PPO has a list of preferred providers, but unlike the HMO, the patient can still be covered if they choose to see a doctor that isn't on the list. There are two types of deductibles involved in a PPO plan. The first, is a deductible to be paid when the patient sees a doctor recommended by my the insurance company. The second type of deductible requires the patient to pay a higher deductible to see a doctor of their choice, not recommended by the insurance provider.
While both types of plans have their pros and cons, an HMO plan is typically less expensive to maintain. One of the major cons of an HMO plan is that because the list of providers may be small, you may have a longer wait to see a doctor in a non-emergency situation. PPO plans while generally more expensive than the HMO, allow the patient to find a doctor they want to take care of them. Each company is different, so it is imperative that the patient check the list of health care providers on both types of plans when deciding which will fit their lifestyle.