Many health insurance companies offer both PPOs and HMOs. In general, HMO policies tend to be less expensive, while also including many more restrictions on your benefits, especially in terms of which medical providers you can use. PPOs tend to be more expensive, but also offer you the option to see a much wider variety of medical providers, usually without the need for a referral before seeking care from any specialists.
There are several ways to determine if your health insurance plan is an HMO or PPO:
1. Sometimes that information is shown right on your insurance card or in the plan name
2. You can look up your plan information online or go through the material your carrier sent you
3. Last resort is to contact your agent or the carrier and ask them!
HMO's require you to use network doctors and specialists and "most" require a referral to a network specialist from your Primary Care Physician (PCP), who is also in the network.
If you are in a PPO, you "may" be required to have a PCP, but you are not required to get a referral to a specialist: you can go to any specialist you choose, as long as they are in the PPO network.
In either case, you "may" be responsible for up to 100% of the expenses if you go to a doctor that is not in the network.
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1. Sometimes that information is shown right on your insurance card or in the plan name
2. You can look up your plan information online or go through the material your carrier sent you
3. Last resort is to contact your agent or the carrier and ask them!
HMO's require you to use network doctors and specialists and "most" require a referral to a network specialist from your Primary Care Physician (PCP), who is also in the network.
If you are in a PPO, you "may" be required to have a PCP, but you are not required to get a referral to a specialist: you can go to any specialist you choose, as long as they are in the PPO network.
In either case, you "may" be responsible for up to 100% of the expenses if you go to a doctor that is not in the network.
Best bet is to call your agent or carrier!