Choosing Between HMO Health Insurance and PPO
You are in the process of choosing between PPO and HMO health insurance. PPO seems to be a good choice, but HMO isn’t too bad either. So, which insurance is really the best deal?
To help you decide, here’s a health insurance comparison on these two popular types of insurance:
Health Maintenance Organization (HMO)
HMO is a type of managed care organization. It’s health care providers are contracted to provide affordable health coverage at a fixed rate.
Members carrying HMO health insurance must choose a Primary Care Physician (PCP) within the HMO network. Choose carefully, for this PCP will be responsible for overseeing your medical care. This is your go-to doctor in order to receive referrals to visit a specialist – who must also be in the HMO network.
HMO health insurance has some advantages. Its biggest one is low cost. It offers low monthly premiums and co-payments. There’s no annual deductible to meet.
Whether you have an individual health insurance policy or a family insurance policy, HMO health insurance covers medical services involving doctors, specialists, clinics, and hospitals – including emergencies and outpatient surgeries. Even prescription drugs are covered.
Along with these benefits, you get access to highly trained professionals – minus dealing with the excess paperwork involved in making a claim. Simply show your HMO health insurance card, and that’s it.
Without a doubt, HMO health insurance provides affordable health coverage as well as some other benefits.
HMO health insurance does have its disadvantages too. One of those disadvantages is its restricted nature. You must absolutely stay within the HMO network in order to have all medical care covered. There is one exception to this strict requirement: if you’re traveling away from your home and need emergency care, then HMO health insurance will cover it, up to certain limits. This is where travel health insurance or international travel health insurance might come in handy if you plan to travel a lot.
As stated earlier, your PCP will be responsible for giving you all referrals to see a specialist. Without a referral, HMO health insurance won’t cover your medical expenses.
Preferred Provider Organization (PPO)
PPO is another type of managed care organization. Like HMO, health care providers are contracted to provide medical care. Unlike HMO health insurance, however, you can see a medical specialist without a referral from your PCP. PPO provides more flexibility with its health insurance. PPO members can visit health care providers in or out of the PPO network. This gives its members extended access to top quality health care professionals.
A family or individual health insurance policy with PPO is covered for medical care such as preventive, emergency, hospital stays, and outpatient surgeries. Prescription drugs as well as seeing a specialist are also covered with this health insurance. PPO – like HMO – isn’t without its disadvantages.
PPO health insurance often requires a deductible from its members. This is especially the case with hospitalization. Also, PPO has larger co-payments than HMO health insurance. And although you have the flexibility of going outside PPO’s network, it won’t necessarily pay full coverage. PPO will actually pay less of your medical expenses.
In short, PPO is more expandable than HMO, yet higher in cost. Nonetheless, PPO still offers affordable health coverage for individual and families.
Which is Best – HMO or PPO?
So, getting back to the question, “which is a better deal – HMO or PPO?”
The answer depends on you and your needs. If you need the lowest affordable health coverage, then without a doubt, it’s HMO health insurance. PPO is your answer if you want flexibility and more options for facilities. However, the decision is still up to you as you consider everything stated here as well as your own personal situation regarding these two health insurance plans. Just know that regardless which insurance plan you choose, you will be getting good health care from top quality professionals.
