What is the Difference Between an HMO and a PPO?

Health insurance can be confusing for first-time buyers living in Chandler, AZ. Most insurers require you to choose between an HMO and a PPO, yet you may not understand what these terms mean or how they affect your access to medical care. San Marcos Insurance Group can help explain the differences and direct you toward a policy that meets your needs.

The Size of Your Healthcare Network

HMO is an acronym for Health Maintenance Organization, while PPO stands for Preferred Provider Organization. Choosing between the two isn’t complicated when you understand the differences. Both involve a network of healthcare providers. The main differences between those options are the size of the provider network, the flexibility of coverage, payments for in-network and out-of-network doctors, and monthly premium payments.

HMO plans generally have lower costs for patients. In exchange for the lower cost, you have a smaller network of providers and must stay within the network to get medical care. Most insurers also require you to select a primary care provider who can refer you to a specialist when needed. These plans only pay for care within the network except when you have an emergency.

PPO plans typically have higher monthly premiums in exchange for flexibility. You can see a provider outside the network, but co-pays are generally higher. Most don’t require you to choose a primary care provider. You can also see specialists at any time without a referral.

Which Plan is Better for Me?

An HMO may be the best option if you are on a tight budget. However, if you already have a doctor you like, you may prefer a PPO. The San Marcos Insurance Group staff serving Chandler, AZ, can help determine which health plan is best for you. Contact us today for an appointment.