HMO PPO

The choice of HMO, PPO or other health insurance plans will depend upon your health needs, budget, and the available health insurance types in your location. We tried to simplify one of the most common questions that consumers have, and that is the difference between an HMO and a PPO health plan. You need to have a good understanding of the options available to you when selecting a health plan for yourself or selecting from a range of company offers.

HMO (Health Maintenance Organization) - The coverage like this includes a network of medical providers. Such providers include doctors, hospitals, pharmacies, and other service providers. Since they agree to the terms of the network,these providers are included. The terms also include the cost guidelines. In return,a medical provider is assured of a steady stream of patients from being included on the published list.

An insured person must almost always seek a network provider in order to be covered. In return, they usually get the most coverage with the lowest copays and coinsurance compared to other types of health care plans. Managed care plans like this are usually very simple for the consumer to use, and the medical provider will handle most of the paperwork and billing.

PPO (Preferred Provider Organization) Health Plans - LIke HMO plans, PPO plans use a network of medical providers. If the insured person uses that network they will get the highest levels of coverage, and have the least out of pocket expenses. They will also be allowed to use non-network providers in an emergency situation, and may be able to seek exceptions in other special situations. Of course, these non-emergency exceptions should always be pre-approved!

No one plan works out best for everybody. Many people enjoy the simplicity of HMO plans, especially if they live in an area with a large and active network. Others want the freedom to seek medical services outside the network, and those people would probably be happier with a PPO. Of course, your choice will also depend upon what plans are available in your local area, and upon your budget and medical needs.