What is the difference between an HMO and a PPO?

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2012-07-04 12:23:53

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This is an important difference to understand. If your healthcare options include the choice between an HMO and a PPO, you will need to determine whether or not your trusted doctors participate and, if not, if you will be able to afford your share of their fee if you opt for a PPO. Some women feel the value of continuity, using a doctor they have seen for years, provides more secure diagnoses. In that case, you could pay for outside of network medical care. Be sure you know what each system offers so you can estimate your actual healthcare costs.

A health maintenance organization (HMO) and a preferred provider organization (PPO) are both managed care plans. A managed care plan is a method of paying for and providing health care for a set fee using a network of hospitals, doctors, and other health-care professionals. The managed care plan monitors (and sometimes limits) the care that its doctors provide to members. Its goal is to ensure that unnecessary and expensive services to its members are minimized.

HMOs are the most popular form of managed care. Here, all health services and financing go through one organization. Services include inpatient and outpatient care and prescription drug benefits. The HMO offers a network of hospitals and health-care professionals that its members must use. These health-care professionals are either employed by or under contract to the HMO. Members pay a monthly fee that does not change (unless, for example, the entire fee structure changes annually) regardless of the care they may need. Paper work for claiming the fee for the service is done by the provider (doctor) or by PCP.

PPOs are far less restrictive than HMOs. A PPO consists of a group of hospitals and health-care professionals who agree to provide care to members at a reduced cost. A PPO is designed to provide affordable health care while maintaining flexibility for its members, who do not have to use the services within the network but are encouraged to do so. Staying within the network means that their costs are lower. If members go outside the network, they are still covered but must pay a higher deductible and contribute a higher co-payment. The policy holder has to claim from the insurance company for reimbursement. Apart from this there are other plans in PPO:

  • Beneficial Plans - Offers you a chance to waive deductibles,
  • Beneficial Rx Plan - Same as the Beneficial Plans in waiving deductibles, and also offers lowers costs on prescriptions.
  • Preferred Plan - You can choose the medical provider, plus the monthly bill you pay on this plan is quite reasonable.
  • Traditional Plan - You can choose your own medical provider and the rate on this is not costly
  • Plus Plan - You pay a reasonable rate here and get lower out-of-pocket expenses as well.
  • Health Savings Account - You pay a high deductible, but are exempted from tax on serious health expenses.
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2010-03-02 01:26:14

HMO and PPO and different health plans which vary slightly. An HMO plan will require you to see one doctor at an HMO appoved hospital. A PPO plan lets you change your doctor and specialist frequently.

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Q: What is the difference between an HMO and a PPO?
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How can one explain what HMO vs PPO is?

The major difference between HMO and PPO is the fact that HMO lets individuals choose doctors within a specific network, while PPO allows patients to choose their own health care provider.


Even though the HMO is the health care plan that most people have because it is the one offered by their employer, many people either overlook or do not consider the HMO's big brother, the PPO. The PPO offers much more freedom to a policyholder than does an HMO, and aside from slightly higher premiums, the services of a PPO are much more straightforward and basically outstrip an HMO in all respects. Employees should consider a PPO as a gap policy, to cover anything that an HMO does not, and to cover their family if their employer policy does not. It is simply much easier to go to doctors that you wish to go to and see specialists at any time with a PPO.

What are the differences between PPO health insurance and HMO?

PPO stands for Primary Provider Organization, which means you can see phycians "in or out of network". Out of network will always be more money out of pocket to the insured. HMO stands for Health Maintanance Organization. HMO's do not have "out of network" benefits. HMO's are much more restricting because you are limited to the physicians and facilities that may be used.

Does Blue Cross Blue Shield have HMO or PPO?

Blue Cross Blue Shield has both HMO and PPO insurance available. You pick the one that best suits your needs.

What is the difference between a Preferred Provider Organization and Health Maintenance Organization in Kansas.?

HMO's integrate health care providers with insurance.In PPO's you pay less when using in-network providers.

How do you know if insurance is hmo or ppo?

Ask Woka Flocka Flames!

You have an hmo insurance plan in Virginia your husband spends a lot of time in New York and is not covered by your hmo if you switch to a ppo will he be covered in N.Y. and if he is will it cost more?

Yes and Yes. An HMO provides coverage for in-network providers only and a PPO plan will cover both in and out-of-network providers. That is the main difference between the plans. However PPO rates are typically higher than HMO rates. Also if using an out-of-network provider, reimbursement is almost always based on a deductible/coinsurance arrangement with the plan typically paying either 70% or 80% of the bill after the deductible has been paid by you.

Who is the best dental insurance PPO or HMO?

PPO and HMO, both are acceptable dental insurance. PPO dental insurance allows you to concern other dentist with some limitation coverage. HMO dental insurance provides expert dentist in their network to offer best treatment. You can choose any insurance plan which suits you the best.

Are braces cheaper with a PPO or HMO dental plan?

PPO is always better you pay more for it but it pays off as soon as you use it

Which is better-a ppo or an hmo healthcare plan?

The one that is better depends on your actual medical needs, and your desire for flexibility with the doctors that you see. In a HMO, you are restricted to a network of doctors, and typically there is no coverage if you go to an out of network doctor. In a PPO, you get more affordable coverage when you stay in network but you can go out of network if you have to. You still have coverage out of network in a PPO, but you pay more before the insurance pays. For these reasons, HMO's are less expensive than PPO's.

Does oak hill hospital take humana insurance?

Yes, Oak Hill Hospital accepts Humana PPO, HMO, Medicare+Choice PPO and HMO, Humana Tricare and Humana Veteran's Healthcare Services.

What benefits come with an HMO plan?

Each HMO plan is different. Most are less flexible then PPO plans and have certain restrictions on them.

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