What is the Difference between HMO and PPO

HMO and PPO

The difference between HMO and PPO Plans:

As health insurance agents, we get this question on daily basis. Although not many marketplace plans are offering PPO plans, yet it is important to understand the difference between the two networks. Note that some health insurance carriers have POS networks or EPO networks. In this article will describe the meaning of each of the network types. You can always consult with your insurance agent about the best plan option for you.

What Does PPO Network Mean?

Preferred Provider Organization (PPO)

The key feature of the  PPO plans is the freedom to choose any provider within the PPO network without requesting a referral from your PCP (primary care provider). PPO networks vary between a health insurance company and another. For example BCBS of Illinois offers a PPO plan that have providers in network statewide. These providers may or may not accept HMO plans. Some providers however, only accept PPO plans. In the state of Illinois Blue Cross Blue Shield of Illinois is the only provider that offers PPO plan. The name of the plan is Blue Cross Blue Shield Preferred Choice PPO plan. Alternatively, Blue Cross Blue Shield of Texas do not offer any PPO plans on the marketplace. They only offer PPO plans for employer plans or group health plans.

In addition, PPO networks allows the insured to seek coverage from out of network providers or out of state providers. This feature is helpful to individuals who would like to see certain providers at research centers that accept limited plan types. Note that although some PPO plans offer out of network coverage, yet the deductible and out of pocket max is higher when you see providers out of Network.

What Does HMO Network Mean?

Health Maintenance Organization (HMO)

HMO plans are the opposite of PPO plans where they have narrower network wot participating providers and hospitals. These plans focus and encourage the holistic health of their enrollees to lower the cost of medical care. The HMO plans mandate having a a primary care provider (PCP) selected. The PCP acts as the gatekeeper and the referral source to specialists. HMO plans are generally more affordable than PPO plans and have lower premiums. Nonetheless, some HMO plans waive the requirement to have a referral from your PCP to see a specialist. For example, Bright Health plans do not requires their enrollees to request a referral from their pcp to see a specialist as long as the specialist is within network.

Reasonable access to the healthcare networks

You can see a doctor without a referral from PCP

Need a referral from your PCP to see a specialist

Lower Premiums or deductibles

Out of Network Coverage

HMO Plans

PPO Plans

✅ (check with insurance carrier)

What Does POS Plan Mean?

Point of Service Plans:

A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist. Aetna and UnitedHealthcare have successfully established many of their plan offerings via POS networks. Although these health insurance carriers have POS plans they also offer PPO and HMO plans.

 

What Does EPO Plan Mean?

Executive Provider Organization (EPO):

A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency). Oscar and Friday health insurance is known to offer EPO plans in Texas.

Sometimes your providers may not participate in a certain EPO network, make sure to choose a plan that is accepted by your provider. Our health insurance quoting platforms have made the process of finding health plan easier than even.

Simply Click Here to get started.

 

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