Difference Between a PPO and an HMO

The insurance field is full of many different terms and acronyms. You might be wondering about the difference between a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO). We want to clear up any type of confusion. Let’s take a look at each one individually, how they differ and distinguish which one might be best for you.


group of smiling doctors with clipboard

Health Maintenance Organization

An HMO has its own network full of hospitals, doctors, and other healthcare providers. The providers within these networks have agreed to allow members to have lower rates and are required to meet certain quality of standards. Because of this agreement, HMOs usually offer lower monthly premiums. However, you have more limited options. In an HMO, you are required to go to a doctor within that network or else you will not be covered. Additionally, if you need to see a specialist for something, you must first get a referral. Usually, referrals expire within a few months and then you are required to get another.

Preferred Provider Organization

PPOs are a little different. They have higher out-of-pocket costs, copays, and monthly premiums. Furthermore, they require you to meet an annual deductible. While they do have higher costs they are much more flexible. Unlike an HMO, PPOs allow you to choose any primary care provider and you are not limited to any type of network.

The main benefits of this are:

  • No referrals are needed to see a specialist.
  • You can see any doctor no matter where you are.
  • You don’t have to change your primary care provider.

Which is Best for You?

Here’s what it boils down to, HMOs are cheaper but are more restricted. PPOs are more expensive, but they have a lot more flexibility. We recommend HMOs for those who only need basic medical coverage. Their low monthly premiums are a great benefit. However, we would not recommend an HMO if you require seeing a lot of specialists. If you don’t mind paying a higher monthly premium than we recommend a PPO because you have more control over your providers.

If you are looking into a PPO or HMO, and want the best plan then give us a call at (844) 410-1320. Or click here to get affordable insurance quotes. We are here to help you and answer any questions you might have.

If you comment below, your question may be the topic of our next post!

See our other websites:

Leave a comment

Your email address will not be published. Required fields are marked *