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Open Enrollment, Mattoon Illinois
Nov
28

What is the difference between an HMO and a PPO health plan?

Posted November 28, 2017 in Insurance Tips, Open Enrollment

With the market place now being in full swing of things, when you are shopping for health insurance you are going to see the main two types of a policies: HMO and PPO. What is the difference between the two? We will answer that below!

A health maintenance organization (HMO) and a preferred provider organization (PPO) have a good amount of differences such as what doctors a patient can see, how much care costs and how important medical records are kept.

 

  • Choice of Health Care Provider

The PPO policy offers you more of a choice and flexibility, but with that comes a higher premium. With a PPO, you are able to see any doctor you wish or visit hospital you choose, within a preferred network of providers. Also with a PPO you do not have to designate a primary doctor and usually see a specialist without referral.

With a HMO policy, it requires you to only see doctors and hospitals on their list of providers. Which means you will need to choose a primary care doctor who will direct care and refer you to approved specialists if one is needed. This option does offer fewer choices and may make switching doctors or getting a second opion a little harder. Most the time, the HMO wil not cover medical expenses that are incurred by seeing someone who is not contracted with the HMO, but usually will have defined coverage for Emergency situations when a patient is outside the normal coverage area.

 

  • Cost Difference

PPO does usually pay a percentage of a person’s medical expenses, with the patient paying the remainder of the balance. HMO’s generally have a set cost for each service, so you can plan accordingly.

 

  • Medical Records

PPO’s usually do not store medical records in one location because you have the option choose what provider you wish to go to. Wish in return can cause a good amount time hunting down all your records.

HMO’s now with you choosing a primary care provider, medical records are kept together within the organization. Also when you are referred to a differ provider/ specialist; any medical records are usually automatically forwarded on your behalf.

Contact us today and we will help you for FREE with your marketplace health insurance plan!

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