HMO’s VS PPO’s

When making a decision for health care many questions come to mind. One of the most important is should you get a HMO or a PPO?

There are similarities but researching the two you will find many differences.

Health Maintenance Organization or HMO you have to select a physician to be your primary care provider. That doctor who is usually part of the insurance carriers network will coordinate all of your medical needs or act as a “gatekeeper”. Any time that you are required to go to a specialist that primary care doctor will refer you to a specialist instead of you picking your own. If you decide to choose a specialist that is not part of the network most of the time you will be required to pay most of the cost. For most employers, selecting a HMO option is least expensive. HMO’s often provide preventive care for a lower copayment or for free in order to keep the insured from developing conditions that would require medical services. In addition, HMO’s have lots of rules that must be followed if you want them to pay your claims. Even if you have to go to the hospital you must have your primary care doctors permission prior to going.

Preferred Provider Organization or PPO is a subscription based medical care arrangement. The actual organization negotiates with providers to set fee schedules, and handle disputes between insurers and the provider. PPO’s are great for people who wish you spend the extra money and want to have more say in their healthcare choices. PPO plans have less restriction but cost more to the patients (insured). The insured has more control over their medical needs and does not need a referral or choose a primary care physician. PPO’s are usually more expensive due the fact that the plan usually covers 80%. Therefore that is usually the reason the copayment is higher. Also, you may have to meet a deductible to meet before coverage starts each year.

Before making any type of healthcare decisions always take a look at all options and make an informed decision. One could work for one that does not work for the other. HMO’s and PPO’s are not perfect. Do the research and pick the one that best suits you and your family.