This information can help you if you're shopping for health insurance and want to learn how HMO and PPO plans are different. All these plans use a network of physicians, hospitals and other health care professionals to give you the highest quality care. The difference between them is the way you interact with those networks. With an HMO plan, you pick one primary care physician. All your health care services go through that doctor. States A to - G Skip to.
States H to - L Skip to. States M Skip to. States N to - R Skip to. States S to - W Skip to. Frequently Asked Questions Caregiver. Medicaid Plans that are low cost or no-cost Medicare dual eligible special needs plans Plans that provide special coverage for those who have both Medicaid and Medicare.
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Everything you need to know about Dual Special Needs Plans in one, convenient guide. Request a Guide. Close modal. First Name. Last Name. Email Address example email. You should carefully review official plan materials.
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Medicare has neither reviewed nor endorsed this information. Sources: Kaiser Family Foundation The Right Coverage at the Lowest Price. Your search for affordable Health, Medicare and Life insurance starts here. Zip Code. But what are they? And, more importantly, how do you decide which is the best one for you? Health Insurance and Provider Networks A network is a group of healthcare providers that have contracted with an insurance company to offer discounted services.
They may also include labs, X-ray facilities, and providers of medical equipment. With a PPO plan, you can see a specialist without a referral. However, there are exceptions for emergencies or routine-care, in-network visits to a gynecologist or obstetrician. You have the freedom to visit any healthcare provider you wish.
HMO vs. What Services Are Covered? Patients must have prescriptions filled at in-network locations to receive coverage. PPOs, meanwhile, allow patients to fill a prescription almost anywhere. However, you may pay more for prescription drugs when using an out-of-network pharmacy. However, today, participants want more options for managed healthcare.
Therefore, many employers offer HMO plans, as well. Because HMO premiums are less expensive, some participants favor HMO plans for their affordability, although services and freedoms typically associated with PPO plans are often restricted. A health insurance deductible is an amount you must pay out of pocket for medical services each year; after you've met it, your insurance coverage kicks in.
PPO plans may have two different annual deductibles. One applies to providers in the PPO network, the other—usually a larger sum—to providers outside the network. The latter is larger because the PPO wants to encourage you to stay in network, using its preferred providers. PPO plans tend to be more expensive than other managed-care options. They typically have higher monthly premiums and out-of-pocket costs, like deductibles.
Often you have both coinsurance and copays. This is the tradeoff for the flexibility PPOs provide, of letting you use providers both within and outside the PPO system, without needing referrals.
Also, the costs for coinsurance and deductibles can be different for in-network and out-of-network providers and services; keeping track of this two-tiered system can be tricky. Finally, some may find it onerous to have more responsibility for managing and coordinating their own care without a primary care doctor.
Both plans cover you whether you use providers and facilities in or out of the network. However, a POS requires you to have a primary care physician and get referrals from them if you want to see a specialist or anyone else. PPOs don't. Costs are another consideration. PPOs tend to be more expensive overall than POS: Their premiums are higher, and they usually come with deductibles that must be met before your coverage begins.
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