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Know Your Health: Find the Best Health Insurance Plan Type for You

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What is the Difference Between an HMO and PPO Plan?

By Network Health marketing and communications team
Originally published on 1/13/2022 at 8:45 a.m.

(Know your health is a new series of articles we’ll be running sharing everything you may need to know when it comes to making informed health insurance decisions).

Health insurance is a decision you’ll make where the factors you considered early on can affect your experiences in and when you use it.

One of the first questions you’ll find when you begin shopping for insurance is whether you should get a PPO or an HMO plan. The dreaded abbreviations have arrived. Luckily, knowing what each plan does well and where it trades off is the way to find out which of these two options is right for you.

What is an HMO health insurance plan?

Short for Health Maintenance Organization, an HMO plan specifies a provider network with which you must work to be covered. This means that you will typically be limited to a primary personal doctor through whom referrals must be conducted before care (with exceptions for care like emergency care, gynecology and more).

The primary thing to note here is that you will see little to no coverage if operating outside of your health care network.

On the other side of things, a preferred provider organization, or PPO, features fewer restrictions on who you can see, either inside your network or outside your network. Adding to that, you can often book appointments directly with a specialist, rather than needing a referral from your primary personal doctor.

Advantages of HMO plans and PPO plans

There isn’t one plan or the other that’s right for anybody. Here are some of the advantages each type of plan enjoys over the other. When making a decision, you’ll want to consider cost, but also whether your existing personal doctor and care providers are in-network and whether or not you frequently require specialist care.

HMO plan benefits

  • Premiums tend to be lower
  • 2In-network medical care requires fewer claims filed
  • Primary personal doctor is able to work with you over time, serving as a manager of your care
  • Often, out-of-pocket costs for items like prescription drugs are lower.

PPO plan benefits

  • Flexibility is the name of the game with an open provider network.
  • Appointments can generally be made with a specialist directly and do not require referrals from a primary personal doctor.

Should I get an HMO or PPO plan?

At the end of the day, the decision between an HMO plan and a PPO plan asks you to consider whether cost or flexibility is more important. At Network Health, we have advisors who can help you pick the plan that perfectly meets your needs, helping you pick a plan that will get you access to your personal doctors and the medications you need at a monthly premium that works with your budget.

For more information on your HMO, PPO and more plan options with Network Health, contact us today.

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