HMO or PPO, What to buy?

HMO stands for Health Maintenance Organization; it is a group of health care providers that have contracted with an insurance company to provide services to its “subscribers’ (Policy Holder) at fixed pre-set prices. HMO’s require its subscribers to elect a primary care physician within their network, HMO’s require a referral from the primary care physician and pre-authorization from the carrier before you can visit any specialist; HMO’s will not cover any out of network physician or hospital visit and are more restrictive on your ability to decide what treatment you may receive. Typically HMO’s are somewhat lower priced plans when compared to PPO’s, physicians are required to see more patients on a daily basis, this will limit the amount of time and services a physician can render to its clients.

PPO stands for Preferred Provider Organization; it’s a large network of Doctors and Hospitals that have contractual agreements with insurance companies; PPO’s are much less restrictive than HMO plans and allow you more control over your medical treatment and who will provide that treatment; you will not need any referral or pre-authorization to visit a specialist of your choice. PPO plans allow its policy holders to visit any in-network or any out of network physician and hospital, however when you visit an in-network physician, you will receive a reduced rate for the services rendered. PPO’s offer a wide array of deductibles, coinsurances and co-pays to help its policy holders customize a plan to suit there coverage and budget requirements.

I have helped thousands of clients over the years with their health insurance needs and I would only recommend a PPO plan.