MHI – Q: What is the difference between an HMO and a PPO?

Posted by MedEd at MHI
A: Although both HMOs and PPOs use provider networks, you’ll want to understand the differences between these two types of insurance.

HMOs, or Health Maintenance Organizations, typically do not allow members to go “off network”. You must go to a network provider. In addition, a referral from your primary care physician is required in order to see a specialist.

PPOs, or Preferred Provider Organizations, allow a little more flexibility. You may go to an out-of-network provider if the provider is willing to accept your insurance – but you’ll pay more to do so, either through a deductible, a higher coinsurance or both. You are not required to obtain a referral prior to seeing a specialist.

In both cases, do your homework. Be sure to make sure all your providers are on the network.

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