What is the Difference Between an HMO and PPO Plan?

Choosing a healthcare plan can be difficult, especially when you are not only making the choice for yourself, but also choosing for your family. You want to make sure that your family has the best care possible. With so many options out there, it is tough to decipher what makes one better than the other. One inquiry that comes up for BenefitSource Insurance Services, Inc. in Aliso Viejo, CA quite often is how to tell the difference between a Health Maintenance Organization (HMO) policy and a Preferred Provider Organization (PPO) policy. Here are some highlights of each policy in order to help with understanding the differing characteristics:

HMO Plans

An HMO policy allows you to see any doctor or visit any hospital as long as it is within network. The providers that make up the network have agreed to lower prices for its members, in addition to providing quality service and standards. There are also more coverage restrictions associated with HMO plans, such as the amount of tests or visits that a policyholder can have within the policy timeframe. Another feature of an HMO plan is that if you need to see a specialist, you will have to visit your primary care physician (PCP) first for a referral.

PPO Plans

A PPO policy offers fewer restrictions when choosing a provider or medical facility. They, too, have a network of preferred doctors, however, you do have the ability to see someone outside of the network. That said, fees will most likely be higher than those associated with in-network physician visits. Another key feature of a PPO plan is that you can go directly to a medical specialist without going to a PCP for a referral.

Trying to decide between health insurance policies is a difficult task. The best thing you can do is as much research as possible on the plans that you might be interested in. If you still need help choosing the right healthcare plan, please contact BenefitSource Insurance Services, Inc. in Aliso Viejo, CA. They will be able to explain your options in detail and advise you on which policy is best for you and your family.