Difference Between HMO And PPO

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Difference Between HMO And PPO. In this article, you will read about what is HMO, what is PPO, and what is the main difference between HMO and PPO. Both the terms are related to each other, but have significant differences between them. Here, we will first understand the main difference between HMO and PPO, then differentiate between them in detail.

In US and many other foreign countries, a citizen is given an insurance plan to receive medical treatment by consulting doctors and various specialists. These insurance plans are pretty expensive. But, the government provides various types of plans, so an individual can choose the health insurance plan according to their needs. The plans may differ in terms of cost, size of the plan network, coverage of out-of-network services, availability of specialists.

There are three types of health insurance plans, i.e. HMO, PPO, and EPO. In this piece of information, we will discuss HMO and PPO.

What Is The Main Difference Between HMO And PPO?

The main difference between HMO and PPO is that the:

-HMO stands for ‘Health Maintenance Organization’. It is a health insurance plan that provides hospitals, doctors and specialists within the local network. It is less expensive.

-PPO stands for ‘Preferred Provider Organization’. It is a health insurance plan that provides hospitals, doctors, and specialists outside or inside the network, according to the desire of patients. It is expensive.

Difference Between HMO And PPO - chart

What Is HMO?

HMO stands for ‘Health Maintenance Organization’. It is a health insurance plan that provides hospitals, doctors and specialists within the local network. It is less expensive. The doctors and specialists working under this insurance plan have agreed to lower their charges without any reduction in their services. It provides very few opportunities to the patients out-of-network.

In HMO, if a patient wants to see a doctor that is out-of-network, he has to pay the extra fees for the entire visit. There are some other conditions, which the patient has to follow in HMO. There is a registration required with PCP (primary care physician). He will determine the treatment that is needed and also refer to the special test and visits.

HMO plan is the best for those, who are less financially capable or are concerned about costs.

What Is PPO?

PPO stands for ‘Preferred Provider Organization’. It is a health insurance plan that provides hospitals, doctors, and specialists outside or inside the network, according to the desire of patients. It is expensive. It has fewer restrictions as compared to other health insurance plans. It allows the patients to seek treatment without any limitations.

PPO does not ask for a referral for special visits or tests from PCP. And also the registration of PCP is not required. It provides your desired services in-network and out-of-network with slightly charges. As it is an expensive health insurance plan but offers higher coverage with effective flexibility.

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