What is the difference between a PPO and an HMO? Which one is considered better?

Preferred provider organizations (PPOs) and health maintenance organizations (HMOs) are both types of managed health-care systems. The corporate structures of these systems are diverse and differ from each other differently. However, an average consumer does not know of such a thing. There are certain aspects that you should know about:

Care from non-network physicians is usually not provided by HMOs. There are certain exceptions for this case as well.

PPO members are not required to stay within the PPO network. There is usually a very high financial inducement that recommends for you to do so.

Deductibles that must be met before insurance benefits begin are usually not set by HMOs. A nominal co-payment for care is paid by HMO members, instead. On the other hand, members of PPO are required to meet a deductible and usually have to pay larger co-payments than HMOs.

A primary care physician (PCP) must be chosen among the HMO member physicians by HMO members. PCP provides basic medical care and must be consulted before seeing a specialist. On the contrary, PPO members do not have to choose a PCP and can refer themselves to specialists independently.

Which one is better, you ask? There really is no one answer. Like other choices in life, you have to make decisions depending on your situation and particular needs.

If, for example, you chose an HMO, you’d have to make sure that your physician is in the HMO network, if not, you would have to look for a new one. From this angle, HMO does have a bit more independency. However, if you were to choose a PPO, you could see a specialist without a referral and keep your current specialist in stead of changing him/her.

If you want to choose between an HMO and PPO, you would have to take time to evaluate what exactly you need and what exactly each system offers.

Contacting your current health insurance company and speaking to them is probably a good idea. Tell them what you want and what type of coverage you prefer. Based on your specific needs, it won’t be difficult for them to evaluate a plan that will be right for you. Keep in mind that health insurance is very important, and taking it lightly won’t be helpful. Take time, speak, and negotiate.