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When Should You Choose an HMO Plan and When Should You Choose a PPO Plan?



Americans who get their insurance through their employer or insure themselves usually have one of two types of insurance plans: an HMO or a PPO. IF you’re confused about which of these plans is the best choice for your healthcare needs, consider the following information before deciding. The HMO (health maintenance organizations) deals with health care that comes from a network of providers. The PPO (preferred provider organizations) deals with deductibles and patients have the choice of visiting in-network or out-of-network providers.

If you have the choice between one or the other, consider your health-care needs, the way you want to deal with billing, and whether or not you value personal choice or a lack of deductible. Here is a list of factors that will help you choose.

An HMO plan is usually less expensive than a PPO.

An HMO plan has more restrictions than a PPO plan. The HMO may be less costly, but there are costs to this perk.

  • With an HMO plan, you are limited to where you can go for care. You must use pre-qualified hospitals and offices
  • With an HMO plan, you must also use a doctor who has been pre-approved
  • For specialist care, you must get a referral from a general doctor first.

A PPO plan is more expensive than an HMO plan.

  • A typical PPO plan has a deductible between $500 and $2000.
  • PPO plans have higher monthly premiums.

A PPO plan is more flexible than an HMO plan. With the added cost of the PPO plan, you’ll be able to have more say on who and where you go for medical care.

  • With a PPO plan, you can see any doctor you would like to see.
  • PPO plans will offer savings when you do see doctors on a pre-approved list.

Who benefits most from the HMO plan:

Who benefits most from the PPO plan:

  • Patients with previous and chronic conditions will benefit from paying a deductible all at once and getting that out of the way.
  • Patients who prefer alternative medicine such as acupuncture or chiropractic.
  • Patients who prefer to choose their own doctors and facilities.

As you decide between an HMO or PPO, ask yourself the following questions. Consider your last year’s medical trends. Were you at the doctor often? Did you find that you prefer to choose your own doctors or do you go so infrequently that you don’t need to be concerned about choosing the specific doctor? If you prefer to use alternative healthcare, that’s yet another thing to take into consideration. Consider your family’s preferences — do you have several checkups to get for all of the family members? The HMO and PPO are different and depending on your needs, you’ll want to make an educated decision.